No abstract

Background Optimizing post-discharge medication adherence is a target for avoiding adverse events. Nevertheless, few studies have focused on predictors of post-discharge medication adherence. Methods The Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study used counseling and follow-up to improve post-discharge medication safety. In this secondary data analysis, we analyzed predictors of self-reported medication adherence after discharge. Based on an interview at 30 days post-discharge, an adherence score was calculated as the mean adherence in the previous week of all regularly scheduled medications. Multivariable linear regression was used to determine the independent predictors of post-discharge adherence. Results The mean age of the 646 included patients was 61.2 years, and they were prescribed an average of 8 daily medications. The mean post-discharge adherence score was 95% (SD = 10.2%). For every 10 year increase in age, there was a 1% absolute increase in post-discharge adherence (95% CI 0.4% −2.0%). Compared to patients with private insurance, patients with Medicaid were 4.5% less adherent (95% CI −7.6% to −1.4%). For every 1-point increase in baseline medication adherence score, as measured by the 4-item Morisky score, there was a 1.6% absolute increase in post-discharge medication adherence (95% CI 0.8% to 2.4%). Surprisingly, health literacy was not an independent predictor of post-discharge adherence. Conclusions In patients hospitalized for cardiovascular disease, predictors of lower medication adherence post-discharge included younger age, Medicaid insurance, and baseline non-adherence. These factors can help predict patients who may benefit from further interventions.

Racial and ethnic disparities in diabetes care have been well documented. While root causes have been explored for some minority groups, less is known about smaller immigrant populations such as Cambodians. In this study, we sought to explore the potential barriers to care for Cambodian patients with diabetes. We conducted five focus groups with three study groups: health care providers, bilingual Khmer frontline staff, and Cambodian patients with diabetes. Focus groups findings revealed that certain cultural beliefs, low health literacy, and language barriers strongly affect Cambodian patients' understanding of diabetes and self-management, as well as clinicians' ability to care effectively for Cambodian patients with diabetes. Our study supports previous literature and also adds several new insights not previously described. We recommend education for health care providers on patient-centered, cross-cultural care with an emphasis on the needs of Cambodians as well as culturally appropriate diabetes education for patients.