Beard Studies How Doctor-Patient Communication About Medication Costs Affects Adherence

The increasing cost of prescription medications can cause more than just financial problems for patients – high out-of-pocket medication expenses can lead patients to take their medications incorrectly or not at all.

Ashley Beard, right, discusses one of her research projects with an applicant during the School’s annual Graduate Student Recruitment Weekend. Beard’s dissertation focuses on cost as a feature of patient-physician communication in medical visits.

Ashley Beard, a third-year graduate student in the Division of Pharmaceutical Outcomes and Policy, believes it is important to study the role of cost in discussions between physicians and patients when medications are prescribed.

“While it is generally agreed that medication costs should be taken into account in prescribing decisions, little is known about how patients and physicians discuss medication costs in medical visits, if such discussions impact medical decision making, and if patients are more satisfied with their medications if they discuss cost issues with physicians,” Beard says.

Beard’s dissertation research focuses on cost as a feature of medication management communication in medical visits. She plans to examine how discussions about medication cost between patients and doctors affect subsequent patient-reported medication adherence. Adherence is a major problem in the United States, where it is estimated that as many as half of the prescriptions filled each year are taken incorrectly.

“For years, people have studied the factors that predict adherence—is it race, income, type of disease?” Beard says. “While numerous factors have been studied, none have demonstrated consistent relationships with poor medication adherence.”

Beard says researchers are increasingly looking at the relationship factors between physicians and patients as a possible determinant of medication adherence.

For her research, Beard is analyzing data previously collected for a study by Betsy Sleath, PhD, a professor in the Division of Pharmaceutical Outcomes and Policy. The study, “Older Adults and Drug Decisions: Collaborations and Outcomes,” examined patient-physician communication on a broader level. Sleath serves as Beard’s adviser and mentor.

The study includes survey and audiotape data from clinic visits collected in North Carolina between 2003 and 2005. Information was gathered from eight rheumatologists and two hundred adult patients with rheumatoid arthritis (RA).

Beard says that RA is an ideal condition to use to examine communication about medication costs because of the prevalence of medication therapy, the need for continuous treatment, and the wide-ranging costs of the medications used to treat RA. Some medications, such as prednisone, cost only cents on the dollar; while other new medications are laboratory-derived and can cost hundreds of dollars a month even for patients with good prescription drug insurance.

Beard has completed a preliminary study of some of the data. She found that more than 30 percent of the visits she analyzed included discussions about medication costs. Patients talked with their doctors about insurance coverage and prescription drug assistance programs. Some patients even asked about medications purchased outside of the United States.

For her dissertation, Beard will focus on what she calls the “culture of prescribing” by examining what happens from the joint perspective of the physician and the patient. That will include examining how discussions about cost affect patient-reported medication adherence and what doctor and patient characteristics influence communication about medication cost.

Beard hopes that her research will lead to a better understanding of physician-patient communication about medication costs that can lead to improved communication between doctors and patients. Improving this, Beard says, can also have benefits for pharmacists.

“Improvements in communication about medication costs have potential system benefits by relieving pressure from busy pharmacists who often have to contend with the requirements of their patients’ prescription drug coverage,” Beard says.