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Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.

Voils CI, Sleath B, Maciejewski ML - BMC Health Serv Res (2014)

Bottom Line: This qualitative study was conducted to understand the reasons why patients have increasing numbers of prescribers of medications and to understand patient perspectives on advantages and disadvantages of having multiple prescribers, including effects on medication supply.Patients seeking non-VA care had to coordinate own their care by sharing prescriptions and test results to their prescribers within and outside VA.Prescribing physicians should engage in open dialogue with patients to create a shared understanding of patient and provider goals and priorities for chronic disease medications.

View Article: PubMed Central - PubMed

Affiliation: Department of Veterans Affairs, Center for Health Services Research in Primary Care, Durham VAMC, 508 Fulton St. (152), Durham, NC, 27705, USA. corrine.voils@mc.duke.edu.

ABSTRACT

Background: Patients with multiple chronic conditions often have multiple prescribers, which has been associated with greater health care utilization and medication nonadherence in claims-based analyses. This qualitative study was conducted to understand the reasons why patients have increasing numbers of prescribers of medications and to understand patient perspectives on advantages and disadvantages of having multiple prescribers, including effects on medication supply.

Methods: This qualitative study involved three focus groups comprising 23 outpatients from a single Veterans Affairs (VA) Medical Center with at least one chronic cardiometabolic condition (hypertension, diabetes, dyslipidemia, or congestive heart failure). Participants were asked about their experiences, including perceived of advantages and disadvantages, of having multiple prescribers of cardiometabolic medications. Conventional content analysis was used to analyze the data.

Results: Multiple prescribers arose through referrals and patients actively seeking non-VA prescribers (primary care and/or specialist) to maximize timeliness and access to medications, provide access to medications not on the VA formulary, and minimize out-of-pocket costs. Patients seeking non-VA care had to coordinate own their care by sharing prescriptions and test results to their prescribers within and outside VA.

Conclusions: Prescribing physicians should engage in open dialogue with patients to create a shared understanding of patient and provider goals and priorities for chronic disease medications.

No MeSH data available.


Related in: MedlinePlus

Flow diagram for Durham VA patients.
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Fig1: Flow diagram for Durham VA patients.

Mentions: Eligible participants had one to four cardiometabolic conditions (i.e., hypertension, type 2 diabetes, hyperlipidemia, or congestive heart failure). We chose to focus on these conditions because they are concordant, meaning that they are related in their pathogenesis and require a similar care plan [11]. These conditions are also the most prevalent and costly chronic in the US [12,13], and associated morbidity and mortality can be reduced significantly by medication adherence. This cohort was established via electronic medical record data to address several research questions, one of which is reported herein. Details on sample selection have been reported [2]. The final study sample after exclusions (e.g., death during the study years) for the claims analyses comprised 7,933 veterans (FigureĀ 1). From the 7,933 patients, 1,999 were randomly selected to receive a mail survey addressing other study aims (results not presented herein). From the 1,999 veterans who were sent surveys, 300 veterans (regardless of whether they were survey responders or non-responders) were randomly selected to receive a recruitment letter for this focus group study.Figure 1


Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.

Voils CI, Sleath B, Maciejewski ML - BMC Health Serv Res (2014)

Flow diagram for Durham VA patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4233094&req=5

Fig1: Flow diagram for Durham VA patients.
Mentions: Eligible participants had one to four cardiometabolic conditions (i.e., hypertension, type 2 diabetes, hyperlipidemia, or congestive heart failure). We chose to focus on these conditions because they are concordant, meaning that they are related in their pathogenesis and require a similar care plan [11]. These conditions are also the most prevalent and costly chronic in the US [12,13], and associated morbidity and mortality can be reduced significantly by medication adherence. This cohort was established via electronic medical record data to address several research questions, one of which is reported herein. Details on sample selection have been reported [2]. The final study sample after exclusions (e.g., death during the study years) for the claims analyses comprised 7,933 veterans (FigureĀ 1). From the 7,933 patients, 1,999 were randomly selected to receive a mail survey addressing other study aims (results not presented herein). From the 1,999 veterans who were sent surveys, 300 veterans (regardless of whether they were survey responders or non-responders) were randomly selected to receive a recruitment letter for this focus group study.Figure 1

Bottom Line: This qualitative study was conducted to understand the reasons why patients have increasing numbers of prescribers of medications and to understand patient perspectives on advantages and disadvantages of having multiple prescribers, including effects on medication supply.Patients seeking non-VA care had to coordinate own their care by sharing prescriptions and test results to their prescribers within and outside VA.Prescribing physicians should engage in open dialogue with patients to create a shared understanding of patient and provider goals and priorities for chronic disease medications.

View Article: PubMed Central - PubMed

Affiliation: Department of Veterans Affairs, Center for Health Services Research in Primary Care, Durham VAMC, 508 Fulton St. (152), Durham, NC, 27705, USA. corrine.voils@mc.duke.edu.

ABSTRACT

Background: Patients with multiple chronic conditions often have multiple prescribers, which has been associated with greater health care utilization and medication nonadherence in claims-based analyses. This qualitative study was conducted to understand the reasons why patients have increasing numbers of prescribers of medications and to understand patient perspectives on advantages and disadvantages of having multiple prescribers, including effects on medication supply.

Methods: This qualitative study involved three focus groups comprising 23 outpatients from a single Veterans Affairs (VA) Medical Center with at least one chronic cardiometabolic condition (hypertension, diabetes, dyslipidemia, or congestive heart failure). Participants were asked about their experiences, including perceived of advantages and disadvantages, of having multiple prescribers of cardiometabolic medications. Conventional content analysis was used to analyze the data.

Results: Multiple prescribers arose through referrals and patients actively seeking non-VA prescribers (primary care and/or specialist) to maximize timeliness and access to medications, provide access to medications not on the VA formulary, and minimize out-of-pocket costs. Patients seeking non-VA care had to coordinate own their care by sharing prescriptions and test results to their prescribers within and outside VA.

Conclusions: Prescribing physicians should engage in open dialogue with patients to create a shared understanding of patient and provider goals and priorities for chronic disease medications.

No MeSH data available.


Related in: MedlinePlus