Hatem Beshir; Ahmed Kamal; Ahmed ElKhanany; Ahmed ... - INRUD

Hatem Beshir; Ahmed Kamal; Ahmed ElKhanany; Ahmed Bassiouni
Dr. Hatem Ahmed Beshir, MBBCh
Resident of Cardiothoracic Surgery
Faculty of Medicine, University of Alexandria, Egypt

1- Study Aims
2- Problem Statement
3- Methods
4- Results
5- Conclusions
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To Identify cost-reducing strategies, including Cost
related non adherence (CRN).
To Understand how are these strategies employed by
chronically-ill patients presenting to Alexandria
University Hospitals.
To Examine factors affecting prevalence of CRN.
To Explore impact of better Doctor Patient Interaction
(DPI) on CRN.
To Pinpoint the best DPI methods that minimized CRN.
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1. Heisler M, Wagner TH, Piette JD. Clinician identification of chronically ill patients who have problems paying for prescription medications. Am J Med. 2004 Jun
1;116(11):753-8
2. Atella V, Schafheutle E, Noyce P, Hassell K. Affordability of medicines and patients' cost-reducing behaviour: empirical evidence based on SUR estimates from Italy
and the UK. Appl Health Econ Health Policy. 2005;4(1):23-35.
3. Wilson IB, Schoen C, Neuman P, Strollo MK, Rogers WH, Chang H, Safran DG. Physician-patient communication about prescription medication nonadherence: a 50-
state study of America's seniors. J Gen Intern Med. 2007 Jan;22(1):6-12.
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4. World Health Organization Statistical Information System (WHOSIS) . World Health Statistics 2010. [Online]. 2010 Apr;(1):130-3. [cited 2010 Aug 18]. Available from:
http://www.who.int/entity/whosis/whostat/EN_WHS10_Full.pdf
5. Arab Republic of Egypt Central Agency for public mobilization and statistics health status report 2010. [Online].
6. Tamblyn R, Laprise R, Hanley JA, Abrahamowicz M, Scott S, Mayo N, Hurley J, Grad R, Latimer E, Perreault R, McLeod P, Huang A, Larochelle P, Mallet L. Adverse events
associated with prescription drug cost-sharing among poor and elderly persons. JAMA. 2001 Jan 24-31;285(4):421-9.
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6. Piette JD, Heisler M, Krein S, Kerr EA. The role of patient-physician trust in moderating medication nonadherence due to cost pressures.
Arch Intern Med. 2005 Aug 8-22;165(15):1749-55. 6

Multivariate analysis using
binary Logistic regression
model revealed
Income Ratio :Drug cost to
monthly income ratio ,P=.003
Education: (P=.028) (University 14.2%
- High School 23.8% - Elementary
26.7% - No Education certificate
35.3%).
Patients adopt multiple
strategies in CRN to adopt with
drug costs (given a score
according to number of
methods used).
Insurance Coverage: (P

Cost Reducing Strategies Adopted by our sample
Percent of Positives
Seeking Alternative Medicine
Ignoring presciption
28.50%
30.50%
Postponing Purchase till payed
55.40%
Rationing
33.40%
Skip Doses
Buy The most important drug
Ask for Cheaper subtitute (Generic)
Borrow money - Debt
49.20%
50.80%
45.20%
58.40%
Axe Houshold Expenses or cut on other …
81.50%
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Discussing Drug Costs With the
Physician
Never mentioned
Yes, Mentioned In advance by the patient
Yes, Mentioned in advance by the physician
22%
Patients Who Discussed Drug Costs
With Physician against CRN
Never Mentioned
Yes, Mentioned in advance by the
patient
Yes, Mentioned in advance by the
physician
117
49%
73
65
29%
30
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CRN -ve patients
(n=48)
CRN +ve patients
(n=255)
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Doctor patient interaction methods to decrease CRN
Mentioned the price of the Drug
50%
Reduced the numbers of medication prescribed
30%
Gave free sample medication of the prescribed
Changed one to cheaper alternative
42.90%
42.70%
Informed how & where to get less expensive …
30%
Mentioned which medications must not be …
Asked if the patient can afford
50%
55%
Showed sympathy about high drug costs
78.00%
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Patients who did not discuss drug costs with physician
Did not have enough trust in the physician
20.30%
Did not have enough time to mention it
23.30%
Did not think this issue important
34.90%
Thought that physician will not help
47.10%
Nobody asked
71%
Being embarrased to mention the problem
75%
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Patient-physician
communication can
be an important
determinant of selfmanagement
behavior and
health outcomes
Clinicians can pay
an important role
with patients who
face problems
paying for
prescription drugs
Ensuring patient
education on drug
costs, showing
strong emotional
support and
reducing poly
pharmacy can
significantly lower
CRN
Encouraging
patients to ask for
cheaper
alternatives
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