Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 3 de 3
Filtrar
1.
Circ Cardiovasc Qual Outcomes ; 13(12): e007070, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33302715

RESUMO

BACKGROUND: Out-of-pocket medication costs for patients who have heart failure with reduced ejection fraction may be an important part of shared decision-making, but cost has generally been excluded from clinical discussions. This study reports patients' perspectives on a decision aid for sacubitril/valsartan that explicitly addresses out-of-pocket costs. METHODS: Structured, in-depth interviews were conducted with 20 patients with heart failure with reduced ejection fraction from 2 medical centers to elicit their views on a publicly available decision aid for sacubitril/valsartan that explicitly incorporates considerations related to out-of-pocket costs. Qualitative descriptive analysis was conducted. RESULTS: Key themes identified were general enthusiasm for decision aids for medication decisions, openness on the part of patients to incorporation of cost into decision-making and the decision aid, requests for greater specificity regarding patient-specific cost, and challenges communicating evidence of benefit in a way that allows patients to make cost-benefit analyses for themselves. Patients also raised questions regarding logistical challenges of incorporating a decision aid into the normal clinical and decision-making workflow. CONCLUSIONS: Patients were receptive to the inclusion of out-of-pocket cost as relevant in a decision aid for sacubitril/valsartan. Key challenges to effective integration of cost in these decisions include developing mechanisms for acquiring reliable patient-specific cost estimates and addressing patients' difficulties (and sometimes skepticism) applying trial evidence to their own situation. In addition, implementation strategies are important to develop to facilitate decision aid integration for routine medical decisions into clinic workflow.


Assuntos
Aminobutiratos/uso terapêutico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Compostos de Bifenilo/uso terapêutico , Tomada de Decisão Compartilhada , Técnicas de Apoio para a Decisão , Custos de Medicamentos , Gastos em Saúde , Insuficiência Cardíaca/tratamento farmacológico , Inibidores de Proteases/uso terapêutico , Valsartana/uso terapêutico , Idoso , Aminobutiratos/economia , Bloqueadores do Receptor Tipo 1 de Angiotensina II/economia , Compostos de Bifenilo/economia , Colorado , Análise Custo-Benefício , Combinação de Medicamentos , Feminino , Georgia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/fisiopatologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Neprilisina/antagonistas & inibidores , Participação do Paciente , Satisfação do Paciente , Inibidores de Proteases/economia , Resultado do Tratamento , Valsartana/economia
2.
Circ Cardiovasc Qual Outcomes ; 13(9): e006255, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32814457

RESUMO

BACKGROUND: Despite concerns about rising costs in health care, cost is rarely an issue discussed by patients and clinicians when making treatment decisions in a clinical setting. This study aimed to understand stakeholder perspectives on a patient decision aid (PtDA) meant to help patients with heart failure choose between a generic and relatively low-cost heart failure medication (ACE [angiotensin-converting enzyme] inhibitor or angiotensin II receptor blocker) and a newer, but more expensive, heart failure medication (angiotensin II receptor blocker neprilysin inhibitor). METHODS AND RESULTS: Feedback on the PtDA was solicited from 26 stakeholders including patients, clinicians, and the manufacturer. Feedback was recorded and discussed among development team members until consensus regarding both the interpretation of the data and the appropriate changes to the PtDA was reached. Stakeholders found the PtDA sufficient in clarifying the different treatment options for heart failure. However, patients, physicians, and the manufacturer had different opinions on the importance of highlighting cost in a PtDA. Patients indicated issues of cost were crucial to the decision while physicians and manufacturers expressed that the cost issue was secondary and should be de-emphasized. CONCLUSIONS: The stratified perspectives on the role of cost in medical decision-making expressed by our participants underscore the importance and challenge of having clear, frank discussions during clinic visits about treatment cost and perceived value.


Assuntos
Aminobutiratos/economia , Aminobutiratos/uso terapêutico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/economia , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Compostos de Bifenilo/economia , Compostos de Bifenilo/uso terapêutico , Técnicas de Apoio para a Decisão , Custos de Medicamentos , Gastos em Saúde , Insuficiência Cardíaca/tratamento farmacológico , Neprilisina/antagonistas & inibidores , Inibidores de Proteases/economia , Inibidores de Proteases/uso terapêutico , Valsartana/economia , Valsartana/uso terapêutico , Aminobutiratos/efeitos adversos , Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Atitude do Pessoal de Saúde , Compostos de Bifenilo/efeitos adversos , Tomada de Decisão Clínica , Análise Custo-Benefício , Tomada de Decisão Compartilhada , Combinação de Medicamentos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/fisiopatologia , Humanos , Participação do Paciente , Inibidores de Proteases/efeitos adversos , Participação dos Interessados , Valsartana/efeitos adversos
3.
J Youth Adolesc ; 48(10): 1899-1911, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446585

RESUMO

Schools are important contexts for adolescent health and health-risk behaviors, but how stable is this relationship? We develop a conceptual model based on Ecological Systems Theory describing the changing role of schools for adolescent health outcomes-in this case, teen e-cigarette use. To examine this change, we fit Bayesian multilevel regression models to two-year intervals of pooled cross-sectional data from the 2011-2017 U.S. National Youth Tobacco Survey, a school-based study of the nicotine use behaviors of roughly 65,000 middle and high school students (49.5% female; 41.1% nonwhite; x̄ age of 14.6 ranging from 9 to 18) from over 700 schools. We hypothesized that school-level associations with student e-cigarette use diminished over time as the broader popularity of e-cigarettes increased. Year-specific variance partitioning coefficients (VPC) derived from the multilevel models indicated a general decrease in the extent to which e-cigarette use clusters within specific schools, suggesting that students across schools became more uniform in their propensity to vape over the study period. This is above and beyond adjustments for personal characteristics and vicarious exposure to smoking via friends and family. Across all years, model coefficients indicate a positive association between attending schools where vaping is more versus less common and student-level odds of using e-cigarettes, suggesting that school contexts are still consequential to student vaping, but less so than when e-cigarettes were first introduced to the US market. These findings highlight how the health implications of multiply-embedded ecological systems like schools shift over time with concomitant changes in other ecological features including those related to policy, culture, and broader health practices within society. Though not uniformly reported in multilevel studies, variance partitioning coefficients could be used more thoughtfully to empirically illustrate how the influence of multiple developmentally-relevant contexts shift in their influence on teen health over time.


Assuntos
Comportamento do Adolescente/psicologia , Estudantes/psicologia , Vaping/psicologia , Adolescente , Teorema de Bayes , Estudos Transversais , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Feminino , Humanos , Masculino , Fumar/psicologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos , Vaping/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA