Which Medicines Do Our Patients Want From Us?
Eighty-four percent of the sample said that reassurance and cold medicine would be enough care for a virus that antibiotics would not help. A significant difference was found by race, with white patients more likely to accept reassurance (76%) than African Americans (51%, X2=11.176, P <.001).
Forty-three percent of the sample would want an antibiotic “just to be sure” if they had a virus (even though 84% said reassurance was sufficient). Sex, race, and HMO membership all influenced this finding with women, African Americans, and patients not in an HMO more likely to want the antibiotic (56% women vs 39% of men, X2=6.020, P <.014; 71% of African-Americans vs 39% of whites, c2= 15.348, P <000; 63% of patients not in an HMO vs 38% of HMO members, X2=11.712, P <.001).
Similar questions were asked in reference to muscle strain: would reassurance be enough? Again, African Americans were less likely to see reassurance as sufficient (55% vs 81%, X2=14.003, P <.000). Seventy-two percent of those responding felt this would be sufficient care. However, 37% stated that they would like muscle relaxers or pain medication just to be sure. Patients who were in an HMO and African Americans were more likely to prefer the medication than those not in an HMO (55% HMO vs 36% non-HMO, X2=6.014, P<.014; 63% African Americans vs 37% whites, X2=9.59, P<.002).
Finally, the same questions were asked about diarrhea, which was most likely caused by a virus. Reassurance was again less apt to be perceived as sufficient by African Americans (50% vs 65%, X2= 3.442, P<.064), and they were more likely to want an antibiotic “just to be sure” (37% vs 23%, X2=3.759, P<.053). The patients not in an HMO were also more likely to want an antibiotic just to be sure (35% vs 21%, X2=4.669, P<.031).
Treatment Change Questions
Two questions were asked about the timing of requests for different treatments. The first had to do with the timing of a change in medicine (assuming the patient was not getting sicker) and the second with the number of medication changes that would be acceptable before requesting a referral to a specialist. Overall, 14% of the respondents would call for new medicine within 24 hours; 22% would call within 48 hours; 31% would call within 72 hours; and 33% would wait longer. In terms of requesting a specialist, 8% of the respondents would accept one medicine change before calling a specialist; 43% would accept 2 changes; 36% would accept 3 changes; and 13% would accept more changes. African Americans and FFS patients would wait for a shorter amount of time before calling for a medication change (F=14.66, P <017; F=6.34, P <013, respectively). No differences were observed by sex, race, or HMO membership status in number of medication changes before going to a specialist.
Discussion
We addressed patient preferences concerning 3 main topics: (1) influence of cost of medicine, (2) use of reassurance as a valid treatment, and (3) timing of treatment changes. Results indicate that patients want expensive medicine if there is a reason to believe it will work better. This finding is particularly true of HMO enrollees who have a set charge for medicine, suggesting that such plans and provisions may change patient preferences in a more costly manner or that patients self-select for membership. The acceptance of reassurance as a valid treatment by many patients belies the stereotype of patients always wanting prescriptions. However, variation in the wording of that question (the switch to whether they would want medication “just to be sure”) significantly reduced the percentage of those who simply accepted over-the-counter treatments and reassurance as adequate treatments. Substantial variation was observed by race, with African Americans consistently not as accepting of reassurance and more desirous of “just to be sure” medication. Although the small sample size precludes the drawing of conclusions, this may be suggestive of cultural differences in health-seeking behavior and also reduced exposure to managed care plans. One possibility is that African Americans may have a higher threshold for consulting a physician and may have tried symptomatic treatment for a longer period of time than whites. Because FFS patients were more likely to be African American, observed differences by race may be because of the covariation of race with insurer type. Future studies should explore these possible explanations.
We also found that patients are willing to accept multiple changes in medicines before seeking specialist care and to wait several days before calling physicians about medication ineffectiveness. African Americans and FFS members were less willing to wait. Perhaps there is a self-selection factor to enrollment in HMOs, or perhaps HMO members change their expectations after enrollment. In any case, these data show that understanding the role of patient preferences and expectations about the care they receive may have some potential for cost saving through the use of reassurance and corresponding patient satisfaction with care that does not always deliver a prescription.
Acknowledgements
The authors wish to thank Pam Stovall and Tracey Barton for their typing of the manuscript.
