A qualitative study exploring financial health literacy, medication cost and shared decision-making in patient provider communication

Abstract

Background:

Financial health literacy is at the intersection of both financial literacy and health literacy and is key to patients knowing the right questions to ask healthcare providers about medical care costs. Health literacy has long been recognized as a factor contributing to health disparities, but efforts to improve access and affordability of medications also involve understanding drug costs and more broadly, having financial health literacy. The goal of this research is to explore the discussions of prescription costs in shared decision-making and how elements of financial health literacy may be present in patient-provider communication. Objective:

The objective of this study is to examine the patient’s perceptions of shared decision- making regarding financial health literacy. This goal is accomplished through three study aims: 1) To examine how patients navigate the health care system as it relates to medication cost, 2) To investigate how patients communicate with providers about cost-related issues impacting their medication use, 3) To explore patients’ preference for a shared decision-making process of medication selection that would include medication cost. Methods:

A purposive sample of individuals with at least one prescription diverse in age, gender, race and ethnicity, number of prescribed medications, and chronic conditions were recruited via flyers, word of mouth and listservs. Semi-structured interviews were conducted, where respondents also completed the Brief Health Literacy Screener and a demographic survey. Interviews were audio-recorded, transcribed, then analyzed and catalogued by three coders using

NVivo. Thematic analysis was used to analyze the data which was an iterative process amongst the three coders. Three rounds of data analysis occurred to come to a full consensus. Results:

Twenty respondents (50% female, 45% male, 5% other) with age ranging from 18 to 76 years old participated. The main themes included patients’ abilities to navigate the healthcare system and the associated medication costs based on how they understand the system, how the patients reacted to their medication expenses, patients’ current communication with their providers, patients’ comfortability influences the communication dynamic between them and their providers, how the current decision-making is occurring amongst patients and providers, understanding different healthcare professionals have a role in their care and patients’ preferences in shared decision-making. Discussion and implications:

Participants do want to engage in shared decision-making with their providers and feel confident in asking clinical related questions to their providers. However, this did not apply to the cost-related questions. Participants did not believe that their providers had the answers to cost-related questions and felt frustrated about insurance related issues. Financial health literacy facilitates patient-provider communication that allows patients to ask questions about therapeutic alternatives and identify potential programs that offer financial assistance.