Prescription Medication Cost-Related Non-adherence among Medicare CAHPS Respondents: Disparity by Hispanic Ethnicity

Frankenfield, Diane L.; Wei, Iris I.; Anderson, Karyn K.; Howell, Benjamin L.; Waldo, Daniel R.; Sekscenski, Edward

doi:10.1353/hpu.0.0314

Cited by 25 publications

(16 citation statements)

References 114 publications

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“…Also, our findings on the racial disparity in CRN between NH black and NH white were consistent with previous studies [36,38,39]. While our study did not indicate a significance gap in CRN between Hispanics and NH white, Frankenfield et al (2010) [40] found a higher prevalence of CRN among Hispanic Medicare enrollees compared to non-Hispanics. Our findings along with these previous studies suggest that social support and fiscal policies should be promoted to reduce the disparities and help these vulnerable populations avert CRN.…”

Section: Discussionsupporting

confidence: 92%

Cost-related medication non-adherence among U.S. adults with diabetes

Kang

Lobo

Kim

2018

Diabetes Research and Clinical Practice

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Aims: To examine factors that affect cost-related medication non-adherence (CRN), defined as taking medication less than as prescribed because of cost, among adults with diabetes and to determine their relative contribution in explaining CRN. Methods: Behavioral Risk Factor Surveillance System data for 2013–2014 were used to identify individuals with diabetes and their CRN. We modeled CRN as a function of financial factors, regimen complexity, and other contextual factors including diabetes care, lifestyle, and health factors. Dominance analysis was performed to rank these factors by relative importance. Results: CRN among U.S. adults with diabetes was 16.5%. Respondents with annual income <$50,000 and without health insurance were more likely to report CRN, compared to those with income ≥$50,000 and those with insurance, respectively. Insulin users had 1.24 times higher risk of CRN compared to those not on insulin. Contextual factors that significantly affected CRN included diabetes care factors, lifestyle factors, and comorbid depression, arthritis, and COPD/asthma. Dominance analysis showed health insurance was the most important factor for respondents <65 and depression was the most important factor for respondents ≥65. Conclusions: In addition to traditional risk factors of CRN, compliance with annual recommendations for diabetes and healthy lifestyle were associated with lower CRN. Policies and social supports that address these contextual factors may help improve CRN.

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Section: Discussionsupporting

confidence: 92%

Cost-related medication non-adherence among U.S. adults with diabetes

Kang

Lobo

Kim

2018

Diabetes Research and Clinical Practice

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“…Our study supports other groups that have presented data on how people of lower socioeconomic status and ethnic minorities report higher rates of cost-related medication nonadherence 37,47,52–57…”

Section: Discussionsupporting

confidence: 91%

Patient-reported financial barriers to adherence to treatment in neurology

Moura¹,

Schwamm²,

Moura³

et al. 2016

CEOR

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ObjectiveMany effective medical therapies are available for treating neurological diseases, but these therapies tend to be expensive and adherence is critical to their effectiveness. We used patient-reported data to examine the frequency and determinants of financial barriers to medication adherence among individuals treated for neurological disorders.Patients and methodsPatients completed cross-sectional surveys on iPads as part of routine outpatient care in a neurology clinic. Survey responses from a 3-month period were collected and merged with administrative sources of demographic and clinical information (eg, insurance type). We explored the association between patient characteristics and patient-reported failure to refill prescription medication due to cost in the previous 12 months, termed here as “nonadherence”.ResultsThe population studied comprised 6075 adults who were presented between July and September 2015 for outpatient neurology appointments. The mean age of participants was 56 (standard deviation: 18) years, and 1613 (54%) were females. The patients who participated in the surveys (2992, 49%) were comparable to nonparticipants with respect to gender and ethnicity but more often identified English as their preferred language (94% vs 6%, p<0.01). Among respondents, 9.8% (n=265) reported nonadherence that varied by condition. These patients were more frequently Hispanic (16.7% vs 9.8% white, p=0.01), living alone (13.9% vs 8.9% cohabitating, p<0.01), and preferred a language other than English (15.3% vs 9.4%, p=0.02).ConclusionOverall, the magnitude of financial barriers to medication adherence appears to vary across neurological conditions and demographic characteristics.

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“…Because we used subjective, retrospective measures of adherence that are prone to biases such as social desirability or memory effects and chose a liberal cut-off, the actual nonadherence rates might be even higher than presented here. This is rather surprising considering that one of the main barriers to adherence, out-of-pocket costs for medication [5], [20] is unlikely an influential factor of nonadherence in Germany. Most of the patients in Germany have health plans with no or only marginal cost sharing for medication.…”

Section: Discussionmentioning

confidence: 98%

Medication Adherence in the General Population

et al. 2012

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BackgroundAdherence to medication is low in specific populations who need chronic medication. However, adherence to medication is also of interest in a more general fashion, independent of specific populations or side effects of particular drugs. If clinicians and researchers expect patients to show close to full adherence, it is relevant to know how likely the achievement of this goal is. Population based rates can provide an estimate of efforts needed to achieve near complete adherence in patient populations. The objective of the study was to collect normative data for medication nonadherence in the general population.Methods and FindingsWe assessed 2,512 persons (a representative sample of German population). Adherence was measured by Rief Adherence Index. We also assessed current medication intake and side effects. We found that at least 33% of Germans repeatedly fail to follow their doctor's recommendations regarding pharmacological treatments and only 25% of Germans describe themselves as fully adherent. Nonadherence to medication occurs more often in younger patients with higher socioeconomic status taking short-term medications than in older patients with chronic conditions. Experience with medication side effects was the most prominent predictor of nonadherence.ConclusionsThe major strengths of our study are a representative sample and a novel approach to assess adherence. Nonadherece seems to be commonplace in the general population. Therefore adherence cannot be expected per se but needs special efforts on behalf of prescribers and public health initiatives. Nonadherence to medication should not only be considered as a drug-specific behaviour problem, but as a behaviour pattern that is independent of the prescribed medication.

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Prescription Medication Cost-Related Non-adherence among Medicare CAHPS Respondents: Disparity by Hispanic Ethnicity

Abstract: Hispanic ethnicity was significantly associated with CRN. More research is needed to understand interventions to eliminate the disparity for this minority group.

Cited by 25 publications

References 114 publications

Cost-related medication non-adherence among U.S. adults with diabetes

Cost-related medication non-adherence among U.S. adults with diabetes

Patient-reported financial barriers to adherence to treatment in neurology

Medication Adherence in the General Population

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