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Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians: A Secondary Analysis of a Randomized Clinical Trial

IMPORTANCE: How patients with atrial fibrillation (AF) and their clinicians consider cost in forming care plans remains unknown. OBJECTIVE: To identify factors that inform conversations regarding costs of anticoagulants for treatment of AF between patients and clinicians and outcomes associated with...

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Autores principales: Kamath, Celia C., Giblon, Rachel, Kunneman, Marlene, Lee, Alexander I., Branda, Megan E., Hargraves, Ian G., Sivly, Angela L., Bellolio, Fernanda, Jackson, Elizabeth A., Burnett, Bruce, Gorr, Haeshik, Torres Roldan, Victor D., Spencer-Bonilla, Gabriella, Shah, Nilay D., Noseworthy, Peter A., Montori, Victor M., Brito, Juan P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278261/
https://www.ncbi.nlm.nih.gov/pubmed/34255051
http://dx.doi.org/10.1001/jamanetworkopen.2021.16009
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author Kamath, Celia C.
Giblon, Rachel
Kunneman, Marlene
Lee, Alexander I.
Branda, Megan E.
Hargraves, Ian G.
Sivly, Angela L.
Bellolio, Fernanda
Jackson, Elizabeth A.
Burnett, Bruce
Gorr, Haeshik
Torres Roldan, Victor D.
Spencer-Bonilla, Gabriella
Shah, Nilay D.
Noseworthy, Peter A.
Montori, Victor M.
Brito, Juan P.
author_facet Kamath, Celia C.
Giblon, Rachel
Kunneman, Marlene
Lee, Alexander I.
Branda, Megan E.
Hargraves, Ian G.
Sivly, Angela L.
Bellolio, Fernanda
Jackson, Elizabeth A.
Burnett, Bruce
Gorr, Haeshik
Torres Roldan, Victor D.
Spencer-Bonilla, Gabriella
Shah, Nilay D.
Noseworthy, Peter A.
Montori, Victor M.
Brito, Juan P.
author_sort Kamath, Celia C.
collection PubMed
description IMPORTANCE: How patients with atrial fibrillation (AF) and their clinicians consider cost in forming care plans remains unknown. OBJECTIVE: To identify factors that inform conversations regarding costs of anticoagulants for treatment of AF between patients and clinicians and outcomes associated with these conversations. DESIGN, SETTING, AND PARTICIPANTS: This cohort study of recorded encounters and participant surveys at 5 US medical centers (including academic, community, and safety-net centers) from the SDM4AFib randomized trial compared standard AF care with and without use of a shared decision-making (SDM) tool. Included patients were considering anticoagulation treatment and were recruited by their clinicians between January 30, 2017, and June 27, 2019. Data were analyzed between August and November 2019. MAIN OUTCOMES AND MEASURES: The incidence of and factors associated with cost conversations, and the association of cost conversations with patients’ consideration of treatment cost burden and their choice of anticoagulation. RESULTS: A total of 830 encounters (out of 922 enrolled participants) were recorded. Patients’ mean (SD) age was 71.0 (10.4) years; 511 patients (61.6%) were men, 704 (86.0%) were White, 303 (40.9%) earned between $40 000 and $99 999 in annual income, and 657 (79.2%) were receiving anticoagulants. Clinicians’ mean (SD) age was 44.8 (13.2) years; 75 clinicians (53.2%) were men, and 111 (76%) practiced as physicians, with approximately half (69 [48.9%]) specializing in either internal medicine or cardiology. Cost conversations occurred in 639 encounters (77.0%) and were more likely in the SDM arm (378 [90%] vs 261 [64%]; OR, 9.69; 95% CI, 5.77-16.29). In multivariable analysis, cost conversations were more likely to occur with female clinicians (66 [47%]; OR, 2.85; 95% CI, 1.21-6.71); consultants vs in-training clinicians (113 [75%]; OR, 4.0; 95% CI, 1.4-11.1); clinicians practicing family medicine (24 [16%]; OR, 12.12; 95% CI, 2.75-53.38]), internal medicine (35 [23%]; OR, 3.82; 95% CI, 1.25-11.70), or other clinicians (21 [14%]; OR, 4.90; 95% CI, 1.32-18.16) when compared with cardiologists; and for patients with an annual household income between $40 000 and $99 999 (249 [82.2%]; OR, 1.86; 95% CI, 1.05-3.29) compared with income below $40 000 or above $99 999. More patients who had cost conversations reported cost as a factor in their decision (244 [89.1%] vs 327 [69.0%]; OR 3.66; 95% CI, 2.43-5.50), but cost conversations were not associated with the choice of anticoagulation agent. CONCLUSIONS AND RELEVANCE: Cost conversations were common, particularly for middle-income patients and with female and consultant-level primary care clinicians, as well as in encounters using an SDM tool; they were associated with patients’ consideration of treatment cost burden but not final treatment choice. With increasing costs of care passed on to patients, these findings can inform efforts to promote cost conversations in practice. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02905032
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spelling pubmed-82782612021-07-19 Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians: A Secondary Analysis of a Randomized Clinical Trial Kamath, Celia C. Giblon, Rachel Kunneman, Marlene Lee, Alexander I. Branda, Megan E. Hargraves, Ian G. Sivly, Angela L. Bellolio, Fernanda Jackson, Elizabeth A. Burnett, Bruce Gorr, Haeshik Torres Roldan, Victor D. Spencer-Bonilla, Gabriella Shah, Nilay D. Noseworthy, Peter A. Montori, Victor M. Brito, Juan P. JAMA Netw Open Original Investigation IMPORTANCE: How patients with atrial fibrillation (AF) and their clinicians consider cost in forming care plans remains unknown. OBJECTIVE: To identify factors that inform conversations regarding costs of anticoagulants for treatment of AF between patients and clinicians and outcomes associated with these conversations. DESIGN, SETTING, AND PARTICIPANTS: This cohort study of recorded encounters and participant surveys at 5 US medical centers (including academic, community, and safety-net centers) from the SDM4AFib randomized trial compared standard AF care with and without use of a shared decision-making (SDM) tool. Included patients were considering anticoagulation treatment and were recruited by their clinicians between January 30, 2017, and June 27, 2019. Data were analyzed between August and November 2019. MAIN OUTCOMES AND MEASURES: The incidence of and factors associated with cost conversations, and the association of cost conversations with patients’ consideration of treatment cost burden and their choice of anticoagulation. RESULTS: A total of 830 encounters (out of 922 enrolled participants) were recorded. Patients’ mean (SD) age was 71.0 (10.4) years; 511 patients (61.6%) were men, 704 (86.0%) were White, 303 (40.9%) earned between $40 000 and $99 999 in annual income, and 657 (79.2%) were receiving anticoagulants. Clinicians’ mean (SD) age was 44.8 (13.2) years; 75 clinicians (53.2%) were men, and 111 (76%) practiced as physicians, with approximately half (69 [48.9%]) specializing in either internal medicine or cardiology. Cost conversations occurred in 639 encounters (77.0%) and were more likely in the SDM arm (378 [90%] vs 261 [64%]; OR, 9.69; 95% CI, 5.77-16.29). In multivariable analysis, cost conversations were more likely to occur with female clinicians (66 [47%]; OR, 2.85; 95% CI, 1.21-6.71); consultants vs in-training clinicians (113 [75%]; OR, 4.0; 95% CI, 1.4-11.1); clinicians practicing family medicine (24 [16%]; OR, 12.12; 95% CI, 2.75-53.38]), internal medicine (35 [23%]; OR, 3.82; 95% CI, 1.25-11.70), or other clinicians (21 [14%]; OR, 4.90; 95% CI, 1.32-18.16) when compared with cardiologists; and for patients with an annual household income between $40 000 and $99 999 (249 [82.2%]; OR, 1.86; 95% CI, 1.05-3.29) compared with income below $40 000 or above $99 999. More patients who had cost conversations reported cost as a factor in their decision (244 [89.1%] vs 327 [69.0%]; OR 3.66; 95% CI, 2.43-5.50), but cost conversations were not associated with the choice of anticoagulation agent. CONCLUSIONS AND RELEVANCE: Cost conversations were common, particularly for middle-income patients and with female and consultant-level primary care clinicians, as well as in encounters using an SDM tool; they were associated with patients’ consideration of treatment cost burden but not final treatment choice. With increasing costs of care passed on to patients, these findings can inform efforts to promote cost conversations in practice. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02905032 American Medical Association 2021-07-13 /pmc/articles/PMC8278261/ /pubmed/34255051 http://dx.doi.org/10.1001/jamanetworkopen.2021.16009 Text en Copyright 2021 Kamath CC et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Kamath, Celia C.
Giblon, Rachel
Kunneman, Marlene
Lee, Alexander I.
Branda, Megan E.
Hargraves, Ian G.
Sivly, Angela L.
Bellolio, Fernanda
Jackson, Elizabeth A.
Burnett, Bruce
Gorr, Haeshik
Torres Roldan, Victor D.
Spencer-Bonilla, Gabriella
Shah, Nilay D.
Noseworthy, Peter A.
Montori, Victor M.
Brito, Juan P.
Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians: A Secondary Analysis of a Randomized Clinical Trial
title Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians: A Secondary Analysis of a Randomized Clinical Trial
title_full Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians: A Secondary Analysis of a Randomized Clinical Trial
title_fullStr Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians: A Secondary Analysis of a Randomized Clinical Trial
title_full_unstemmed Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians: A Secondary Analysis of a Randomized Clinical Trial
title_short Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians: A Secondary Analysis of a Randomized Clinical Trial
title_sort cost conversations about anticoagulation between patients with atrial fibrillation and their clinicians: a secondary analysis of a randomized clinical trial
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278261/
https://www.ncbi.nlm.nih.gov/pubmed/34255051
http://dx.doi.org/10.1001/jamanetworkopen.2021.16009
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