Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions

Fernández-Lázaro, César I; Adams, David P.; Fernández-Lázaro, Diego; García-González, Juan Manuel; Caballero-García, Alberto; Mirón-Canelo, José Antonio

doi:10.1016/j.sapharm.2018.09.006

Cited by 58 publications

(40 citation statements)

References 34 publications

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“…The adherence rate found in our study was consistent with the WHO report that states “in developed countries, adherence among patients suffering chronic diseases averages only 50%” [9]. Compared with previous international studies, the adherence rate assessed in this study was similar to the 53% found in Chinese primary-care centers [31], the 48% reported in uninsured American patients who attended community health centers [32], but slightly higher than the 39% observed in Italian outpatient adults [24]. At the national level, our findings are consistent with prior research in Spain performed in chronic patients [33], but significantly different in terms of the adherence rate of 18% reported in tertiary-care settings [23].…”

Section: Discussionsupporting

confidence: 89%

Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study

et al. 2019

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Background Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings. Methods A cross-sectional study was conducted among 299 adult patients with ≥1 chronic condition(s) and prescribed medication in primary healthcare centers of Spain. The Morisky-Green-Levine questionnaire was used to assess medication adherence via face-to-face interviews. Crude and adjusted multivariable logistic regression models were used to analyze factors associated with adherence using the Multidimensional Model proposed by the World Health Organization — social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Results The proportion of adherent patients to treatment was 55.5%. Older age (adjusted odds ratio 1.31 per 10-year increment, 95% CI 1.01–1.70), lower number of pharmacies used for medication refills (0.65, 95% CI 0.47–0.90), having received complete treatment information (3.89, 95% CI 2.09–7.21), having adequate knowledge about medication regimen (4.17, 95% CI 2.23–7.80), and self-perception of a good quality of life (2.17, 95% CI 1.18–4.02) were independent factors associated with adherence. Conclusions Adherence to treatment for chronic conditions remained low in primary care. Optimal achievement of appropriate levels of adherence through tailored multifaceted interventions will require attention to the multidimensional factors found in this study, particularly those related to patients’ education and their information needs.

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Section: Discussionsupporting

confidence: 89%

Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study

et al. 2019

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“…Cost and pharmacological adherence are major obstacles that preclude standard secondary prevention. 29 This study highlights an important disparity and opportunity for intervention in the free clinic setting.…”

Section: Discussionmentioning

confidence: 92%

Secondary prevention among uninsured stroke patients: A free clinic study

et al. 2020

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Objectives: Free clinics manage a diversity of diseases among the uninsured. We sought to assess the medical management of stroke in a population of uninsured patients. Methods: A retrospective chart review was conducted to collect chronic disease statistics from 6558 electronic medical records and paper charts at nine free clinics in Tampa, Florida, from January 2016 to December 2017. Demographics and risk factors were compared between stroke patients and non-stroke patients. Medication rates for several comorbidities were also assessed. Results: Two percent (107) of patients had been diagnosed with a stroke. Stroke patients were older (mean (M) = 56.0, standard deviation (SD) = 11.2) than the rest of the sample (M = 43.3, SD = 15.4), p < 0.001 and a majority were men (n = 62, 58%). Of the stroke patients with hypertension (n = 79), 81% (n = 64) were receiving anti-hypertensive medications. Of the stroke patients with diabetes (n = 43), 72% (n = 31) were receiving diabetes medications. Among all stroke patients, 44% were receiving aspirin therapy (n = 47). Similarly, 39% of all stroke patients (n = 42) were taking statins. Conclusions: Uninsured patients with a history of stroke may not be receiving adequate secondary prevention highlighting the risk and vulnerability of uninsured patients. This finding identifies an area for improvement in secondary stroke prevention in free clinics.

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“…Chronic condition of the patients included in the study were classified into 7 classes as defined by the ICD-9-CM (International Classification of Diseases, 9 th Revision, Clinical Modification) diagnoses codes with some slight modifications. 26 The interview was taken in English or Bangla, whichever language the participant was more comfortable in. Exclusion criteria included severe cognitive disorders and inability to communicate clearly with the interviewer.…”

Section: Interview Setting and Participantsmentioning

confidence: 99%

Medication Understanding and Health Literacy among Patients with Multiple Chronic Conditions: A Study Conducted in Bangladesh

Rahman

Aziz

Huque

et al. 2020

Journal of Public Health Research

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Objectives: Medication understanding is critical for patients who suffer from multiple chronic conditions in order to reduce medication error and is often associated with poor health outcomesand low adherence. This study aims to identify the gap of medication knowledge among multiple chronic condition patients in Bangladesh, in order to aid physicians and other healthcare providers in improving health literacy.Methods: Individual interviews of a convenience sample of multiple chronic condition patients in Bangladesh were heldwhere they were asked a number of questions for assessing medication related literacy.Results: More than 26% patients failed to cite the brand name of all their prescribed medications while the rate of patients not knowing the generic names was far worse (88.1%). Nearly 1 out of every 4 patients did not know the purpose of all their medications and more than half of the participants (55%) did not know the strengths of their drugs. While knowledge about medication routes and regimen was satisfactory, awareness regarding risk factors of medicine was lowest of all. Only 1 out of every 4 patients had a habit of reading drug information leaflet. Patient’s ability to correctly state the purpose of their medication seemed to be positively associated with age (p=0.004) and negatively associated with number of medicines taken (p=0.03).Conclusions: Many patients demonstrated poor health literacy regarding medication. Routine review of medications from physician or health provider can significantly improve their health literacy, leading to better treatment outcome and medication adherence.

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Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions

Cited by 58 publications

References 34 publications

Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study

Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study

Secondary prevention among uninsured stroke patients: A free clinic study

Medication Understanding and Health Literacy among Patients with Multiple Chronic Conditions: A Study Conducted in Bangladesh

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