Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians

Kamath, Celia C.; Giblon, Rachel; Kunneman, Marlene; Lee, Alexander I.; Branda, Megan E.; Hargraves, Ian; Sivly, Angela; Bellolio, Fernanda; Jackson, Elizabeth A.; Burnett, Bruce; Gorr, Haeshik; Roldan, Victor D Torres; Spencer-Bonilla, Gabriella; Shah, Nilay D.; Noseworthy, Peter A.; Montori, Víctor M.; Brito, Juan P.; Haffke, Alexander; Stier, Amy; Thota, Anjali; LeBlanc, Annie; Simpson, Benjamin; Zeballos-Palacios, Claudia; Vanmeter, Derek; Behnken, Emma; Hess, Erik P.; Ting, Henry H.; Hamilton, James IV; Anderson, Joel; Inselman, Jonathan; Muegge, Jule; Fleming, Kirsten; Olive, Marc; Linzer, Mark; Vang, Miamoua; Ferrara, Michael; Wambua, Mike; Organick, Paige; Cabalka, Renee; Poplau, Sara; Suzuki, Takeki; Abullarade, Carol; Harvey, Lisa; Keune, Shelly; Smith, Timothy L.; Stephens, Shannon W.; Barksdale, Bryan; Hickey, Theresa E.; Peters, Roma; Price, Memrie; Watson, Connie; Wolfe, Douglas A.; Guyatt, Gordon; Haynes, Brian; Tomlinson, George; Daniels, Paul; Gersh, Bernard J.; Jaeger, Thomas M.; McBane, Robert D.

doi:10.1001/jamanetworkopen.2021.16009

Cited by 15 publications

(18 citation statements)

References 33 publications

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“…Second, our study did not examine the quality of communication between patients and physicians, nor did it engage in content analysis to examine all aspects of cost conversations that could both enable and hinder adherence. A recent study by our group 12 found that cost conversations do in fact motivate patients to consider costs in choosing medications, although cost conversations did not impact the final choice of medication. Although our study found that cost conversations may not be associated with medication adherence, these previous findings point to the broad value of bringing costs to the attention of patients and, moreover, may guide clinicians to consider further aspects of cost conversations that might motivate better patient adherence.…”

Section: Discussionmentioning

confidence: 93%

“…Indeed, we have previously found that the clinical encounters supported by shared decision-making (SDM) tools that incorporate cost information increased the incidence of cost conversations compared with encounters not supported by SDM tools. 12 , 13 What is unclear is whether cost conversations with and without the use of SDM tools impact medication adherence.…”

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confidence: 99%

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Impact of Cost Conversations During Clinical Encounters Aided by Shared Decision-Making Tools on Medication Adherence

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Urtecho

LaVecchia

et al. 2022

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Section: Discussionmentioning

confidence: 93%

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confidence: 99%

Impact of Cost Conversations During Clinical Encounters Aided by Shared Decision-Making Tools on Medication Adherence

Suárez

Urtecho

LaVecchia

et al. 2022

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…However, a recent study found that while such discussions were associated with patient consideration of treatment costs, they were not associated with choice of anticoagulant. 20 Given drug cost is associated with adherence, and adherence is associated with stroke risk, physician discussion of anticoagulation costs with patients is an important aspect of informed decision making.…”

Section: Discussionmentioning

confidence: 99%

Informed Decision Making for Anticoagulation Therapy for Atrial Fibrillation

et al. 2022

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Background Patients with atrial fibrillation (AF) must decide between warfarin and direct oral anticoagulants (DOACs), a decision involving important tradeoffs. Our objective was to understand whether physicians engage patients in informed decision making for anticoagulants. Design We performed an analysis of recorded conversations between physicians and anticoagulation-naïve patients in the Verilogue Point-of-Practice database. We assessed the presence of 7 elements of informed decision making, as well as a discussion of financial costs. Results Of 37 encounters with 21 physicians, 92% resulted in a DOAC prescription and 8% resulted in a warfarin prescription. Seventy percent met criteria for discussion of pros and cons, 70% for discussion of the alternatives, 43% presented the decision, 30% included an assessment of patient understanding, 22% included an explanation of the patient’s role in decision making, 22% included an assessment of patient preferences, and 19% included a discussion of uncertainty. Two encounters (5%) included all 7 elements and 9 (24%) included none. Physicians discussed treatment costs with patients in 43% of encounters. Limitations We assessed informed decision making in a single encounter. Physicians and patients may have had other discussions that were not captured in our data. Conclusions Physicians often presented the alternatives but did not generally engage patients in informed decision making. The high rate of DOAC prescriptions is likely the result of physician preferences, as patient preferences were rarely assessed. Implications Strategies to support physicians in engaging patients in informed decision making for anticoagulation are needed. Highlights While physicians discussed the alternatives and presented pros and cons with patients, they rarely assessed patient preferences, explained the patient’s role in decision making, or addressed uncertainty. The cost of treatment with DOACs versus warfarin was discussed by physicians in less than half of encounters, limiting patients’ ability to make informed decisions for anticoagulation. Only 2 encounters (5%) fulfilled all 7 elements of informed decision making.

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“…By examining 830 audiovisual encounter recordings and participant surveys, the authors found that cost conversations occurred in a remarkably high 77% of all encounters and were more likely to occur when shared decision-making tools were used (90% vs 64% of encounters). 5 When examining physician factors associated with having cost conversations, the authors found that clinical load or years in practice did not matter but gender did. 5 Women doctors were more likely to have cost conversations, building on substantial evidence that, on average, they conduct longer visits with patients, engage in more shared decision-making, and have more patient-centered communication styles.…”

mentioning

confidence: 99%

“…5 When examining physician factors associated with having cost conversations, the authors found that clinical load or years in practice did not matter but gender did. 5 Women doctors were more likely to have cost conversations, building on substantial evidence that, on average, they conduct longer visits with patients, engage in more shared decision-making, and have more patient-centered communication styles. 6 These differences are likely attributable to a mix of differing patient expectations, sociocultural norms, and personal characteristics.…”

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confidence: 99%