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Do Patients With Chronic Illnesses Tell Their Doctors?

John D. Piette, PhD; Michele Heisler, MD, MPA; Todd H. Wagner, PhD

Arch Intern Med. 2004;164:1749-1755.

Background  Although many chronically ill patients underuse prescription medications because of cost concerns, we know little about their discussions with clinicians about this issue.

Methods  Nationwide survey of 660 older adults with chronic illnesses who reported underusing medication in the prior year because of cost. We assessed whether patients discussed cost-related medication underuse with clinicians, reasons that some patients did not talk with clinicians about this problem, how clinicians responded when this issue was raised, and how helpful patients perceived clinicians to be.

Results  Two thirds of respondents never told a clinician in advance that they planned to underuse medication because of the cost, and 35% never discussed the issue at all. Of those who did not tell a clinician, 66% reported that nobody asked them about their ability to pay for prescriptions and 58% reported that they did not think providers could help them. When patients talked with clinicians about medication costs, 72% found those conversations helpful. However, 31% reported that their medications were never changed to a generic or less expensive alternative, and few patients were given other forms of assistance such as information about programs that help pay drug costs (30%) or where to purchase less expensive medication (28%). Patients were most likely to find clinicians helpful if clinicians provided free samples, asked about problems paying for prescriptions, and offered advice about how to pay for patients' current regimens.

Conclusions  About one third of chronically ill adults who underuse prescription medication because of the cost never talk with clinicians in advance, and many never raise this issue at all. Clinicians should take a more proactive role in identifying and assisting patients who have problems paying for prescription drugs.

From the Department of Veterans Affairs Center for Practice Management and Outcomes Research, and Department of Internal Medicine, University of Michigan, Ann Arbor (Drs Piette and Heisler); and the Department of Veterans Affairs Health Economics Resource Center, and Department of Health Research and Policy, Stanford University, Palo Alto, Calif (Dr Wagner). The authors have no relevant financial interest in this article.

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