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Understanding the patient experience of cost-related non-adherence to prescription medications through typology development and application

机译：了解通过类型学开发和应用程序对与处方药中的成本相关的患者的患者经验

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Abstract Many patients report skipping doses, splitting pills, or not filling prescriptions due to out-of-pocket costs—a phenomenon known as cost-related non-adherence (CRNA). This study investigated CRNA from the patient's perspective, and, to our knowledge, is the first study to undertake a qualitative investigation of CRNA specifically. We report the results from 35 semi-structured interviews conducted in 2014-15 with adults in four Canadian cities across two provinces. We used framework analysis to develop a CRNA typology to characterize major factors in patients' CRNA decisions. Our typology identifies four major components: (1) the insurance reason driving the drug cost, (2) the individual's overall financial flexibility, (3) the burden of drug cost on the individual's budget, and (4) the importance of the drug from the individual's perspective. The first two components set the context for CRNA and the final two components are the drivers for the CRNA decision. We also found four major patterns in CRNA experiences: (1) CRNA in individuals with low financial flexibility occurred for all levels of drug importance and all but the lowest level of cost burden; (2) CRNA for high importance drugs only occurred when the drug cost had a high burden on an individual's budget; (3) CRNA in individuals with more financial flexibility primarily occurred in drugs with medium importance but high or very high cost burdens; and (4) CRNA for low importance drugs occurred at almost all levels of drug cost burden. Our study furthers the understanding of how numerous factors such as income, insurance, and individual preferences combine and interact to influence CRNA and suggests that policy interventions must be multi-faceted or encourage significant insurance redesign to reduce CRNA. Highlights ? Study of patients' experience of cost-related non-adherence to prescription drugs. ? First in-depth, qualitative investigation of CRNA specifically, to our knowledge. ? CRNA typology includes insurance, financial flexibility, cost burden, and drug importance. ? Cost burden and drug importance are the key drivers of CRNA decisions. ? Clear patterns for low/more financial flexibility and low/high drug importance.
机译：摘要许多患者报告跳过剂量，分裂药，或者由于口袋外的成本而不是填充处方 - 一种称为与成本相关的非粘附（CRNA）的现象。本研究调查了患者的角度来源的CRNA，并且对于我们的知识，是第一次对CRNA进行定性调查的研究。我们向2014 - 15年度的35个半结构化访谈的结果报告了两省的四个加拿大城市的成年人。我们使用框架分析来开发CRNA类型，以表征患者CRNA决策中的主要因素。我们的类型学标识了四个主要组成部分：（1）保险原因推动药物成本，（2）个人的整体财务灵活性，（3）毒品成本对个人预算的负担，以及（4）药物的重要性个人的观点。前两个组件设定了CRNA的上下文，最终的两个组件是CRNA决策的驱动因素。我们还发现了CRNA经验中的四种主要模式：（1）在所有水平的药物重要性发生低金融灵活性中的个人中的CRNA和成本负担的最低级别（2）当药物成本对个人预算中具有很高的负担时，才发生高重视药物的CRNA; （3）具有更多财务灵活性的个体中的CRNA主要发生在中等重要性的药物中，但高或非常高的成本负担; （4）低于重要性药物的CRNA几乎发生了各级药物成本负担。我们的学习使得了解收入，保险和个人偏好等众多因素如何结合和互动以影响CRNA，并提出政策干预必须是多方面的或鼓励重大保险重新设计，以减少CRNA。强调 ？患者对与处方药的成本相关性无粘附经验的研究。还是对我们的知识，首先深入，对CRNA的定性调查。还是CRNA类型学包括保险，财务灵活性，成本负担和药物重要性。还是成本负担和药物重要性是CRNA决策的关键驱动因素。还是明确的模式用于低/更多的财务灵活性和低/高药物重要性。

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