The following article is a part of conference coverage from the American Academy of PAs 2021 Conference (AAPA 2021), held virtually from May 23 to May 26, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading PAs. Check back for more from AAPA 2021.


Many patients with diabetes are concerned about how they will pay for the cost of treatment but are not discussing the issue with their primary care provider (PCP), according to survey findings presented at the American Academy of PAs 2021 Conference (AAPA 2021).

Diabetes is one of the most expensive chronic diseases in the United States and accounts for 1 in 4 health care dollars, explained lead author Maria Dalzell, PA-S, and colleagues. However, little is known about the frequency of patient-PCP discussions on the cost of diabetes treatment.

Continue Reading

“Medical costs are continuously on the rise and I wanted to know if cost-of-treatment was part of a patient’s conversation with their PCP, particularly patients diagnosed with diabetes,” said Dalzell, who is a physician assistant student in the Yale Physician Assistant Program at Yale School of Medicine in New Haven, Connecticut.

Study Participant Selection and Survey Results

The cross-sectional study included English- and Spanish-speaking adults receiving prescription medications for a diabetes diagnosis. Study participants were selected from patients at a single urban primary care clinic who presented between September 2020 and January 2021. The participants were asked to complete a 19-item survey that included questions on patient demographics, annual income, primary insurance, concerns about paying for diabetes treatment, and frequency of cost-of-treatment conversations with PCPs.

Out of 163 patients contacted, 77 (49%) completed the survey. Nearly half of the patients (48%) were Black, 55% were women, nearly 60% earned less than $15,000 annually, and 86% received Medicare or Medicaid as their primary insurance. Key findings are shown in Table 1.

Table 1. Survey Responses Among Patients With Diabetes

VariableYes, n (%) No, n (%)
I have discussed treatment costs with my PCP10 (13%)67 (87%)
I worry or have ever been worried in the past about paying for my diabetes treatment28 (36%)49 (63%)
Diabetes is a financial hardship for me or my family24 (31%)53 (68%)
Paying for my diabetes treatment is difficult21 (27%)56 (73%)

Stepping Up Diabetes Standard of Care

“The survey outcomes revealed only 13% of patients reported having a cost-of-treatment discussion with their PCP, even though one-third of patients surveyed did express concerns about the cost of their treatment,” Dalzell said.

Does this suggest providers should initiate an appropriate conversation with patients about cost-of-care as part of the dialogue shared during a discussion about subjects such as prescribing a new medication and its side effects? It is up to the provider to ascertain the situation and open the door to having meaningful conversations that will improve standards of care and lead to improved treatment outcomes for patients, Dalzell noted.

The study is limited by small sample size and selection of patients from a single clinic. The cross-sectional study design does not establish directionality regarding the level of patient concern and frequency of patient-provider cost of treatment discussions.

The researchers are conducting a concurrent cross-sectional study to evaluate providers’ perspectives about cost-of-treatment conversations.

Visit Clinical Advisor’s meetings section for complete coverage of AAPA 2021.


Dalzell M, Gonzalez-Colaso R, Richards B. Cost-of-treatment conversations between primary care clinicians and patients living with diabetes. Poster presented at: American Academy of PAs Conference; May 23-26, 2021. Poster 117.