Black patients less likely to ask for lower-cost meds
African American patients may feel less comfortable than white patients asking doctors if they can take cheaper drugs, a recent survey from an emergency department shows.
White patients in the study were also more likely to be aware of low-cost prescription drug programs, according to lead author Dr. Preeti Dalawari, of Saint Louis University School of Medicine, and her colleagues.
They said the study supports recommendations that doctors talk with patients about how much drugs cost and ways to overcome high price tags. Such discussions may help people stick more closely to their prescribed medications.
“There are viable low cost pharmacy options that patients, especially those who have difficulty obtaining medication, should be aware of,” Dalawari told Reuters Health in an email.
“If we, as Emergency Medicine physicians, are doing the prescribing, we need to make sure we advocate for the patient and let them know of these options.”
“This is not really a racial issue,” Dr. Robert Solomon, a spokesperson for the American College of Emergency Physicians, said. Instead, it’s “something we ought to be applying across the board.”
Solomon was not involved with the current study. As an emergency department (ED) doctor at Allegheny General Hospital in Pittsburgh, Pennsylvania, he said he teaches doctors-in-training to pay attention to whether what they are recommending is possible for a patient.
“If you make an appointment, will the patient be able to get there?” he said. “If you prescribe a medication, do you know how much it costs? Do you know if the patient can afford it?”
“What we’re dealing with is physicians not doing what they should be doing,” he told Reuters Health.
Dalawari and her team surveyed 552 mostly African American and white adults who came to an urban ED in the Midwest.
Participants answered questions about the affordability of their medications, perceptions about doctors’ habits of prescribing lower-cost medicines and whether they felt comfortable asking doctors for cheaper alternatives to the medicines they were originally prescribed.
Almost half of African Americans said doctors can do a better job of finding cheaper medications. The same sentiment was voiced by one-quarter of white patients.
Yet African Americans were less likely to say they felt comfortable asking doctors for cheaper medications. About 72 percent of them would feel comfortable having that conversation compared to almost 83 percent of whites, the researchers report in The Journal of Emergency Medicine.
Most of the survey respondents - 86 percent - said doctors do a good job of prescribing lower-cost prescription medications, however.
“I found it surprising that 86 percent of the participants actually thought that physicians were doing a good job prescribing low cost medications, given the possible extra steps involved in the ED setting to find this information,” Dalawari said.
The participants reported taking an average of four medications every day, and 44 percent said they were unable to afford at least one of their drugs. One in four respondents said they had trouble paying for their medications at least half of the time.
African Americans were less likely to be aware of pharmacies that offer lower prices for medications. Some large retail pharmacies charge $5 for a 30-day supply of certain drugs, for example. White participants were almost three times more likely than African Americans to be able to name such discount pharmacy options.
The researchers did not look at the reasons for the discrepancies among African Americans and whites. But they are likely due to many different factors, Dalawari said.
The lack of pharmacies close to the homes of some participants may be one factor, she said. Mistrust of the healthcare system among some African Americans may also make them less likely to bring up their needs.
Solomon said these issues can be addressed if doctors pay attention to each patient’s background and knowledge coming in.
“Rather than making assumptions specific to individuals, work from assuming that they may not have resources” readily available, he said.
SOURCE: The Journal of Emergency Medicine, online October 14, 2013.
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Racial Differences in Beliefs of Physician Prescribing Practices for Low-Cost Pharmacy Options
Background Previous studies have reported that certain populations are sensitive to high out-of-pocket drug costs, and drug noncompliance leads to poorer health outcomes.
Objective Our aim was to measure patient awareness of discount pharmacy options, cost barriers to medication access, and beliefs about health care provider’s use of low-cost medications.
Methods This cross-sectional 17-item survey was administered to patients in the emergency department of an urban trauma center in February 2011. Differences in responses by sex and race groups were assessed. A logistic regression model was created to estimate the association of sociodemographic factors and medication use with awareness of discount pharmacy options.
Results Five hundred and fifty-two surveys were analyzed. Among respondents who were prescribed medications within the past year, three fourths of patients felt comfortable asking physicians for cheaper medicines. Slightly more than half were aware of low-cost pharmacy options, and 78% of these respondents correctly listed at least one of these pharmacies. Caucasian patients were more comfortable than African American patients asking for cheaper medicines (82.5% vs. 72.2%; p < 0.05) and were more aware of low-cost prescription programs (63.9% vs. 43.5%; p < 0.001). When adjusted for insurance status and current medication use, Caucasian patients were 2.7 times more likely to name a valid discount pharmacy option compared to African Americans (95% confidence interval 1.85−4.07).
Conclusions This study suggests populations may be more uncomfortable initiating a discussion about medication costs and selection of lower-cost alternatives. Health care providers may need to develop communication strategies in which medication cost is addressed with sensitivity and consistency.
Preeti Dalawari, MD, MSPH, Niral M. Patel, BS, William Bzdawka, PharmD, Jessica Petrone, BS, Victor Liou, BS, Eric Armbrecht, PhD