Prevalence and Persistence of Cost-Related Medication Nonadherence Among Medicare Beneficiaries at High Risk of Hospitalization

Avila, Jorge Luis De; Meltzer, David O.; Zhang, James

doi:10.1001/jamanetworkopen.2021.0498

Cited by 22 publications

(30 citation statements)

References 38 publications

(96 reference statements)

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“…More research is greatly needed to evaluate the adequacy of social policy to help the elderly cope with increasing demand for medications as they age. When CRN was examined longitudinally, one recent study suggested that younger age is a risk factor for persistent CRN 17. The evidence from this study corroborates the supposition that patients’ behaviour may evolve as they age.…”

Section: Discussionsupporting

confidence: 82%

“…The GEE model uses a binomial family function, a probit link function, and an exchangeable correlation structure to address the binary outcome variable and correlation among the longitudinal follow-ups of the respondents. There is no particular order effect in the repeated measures in this analysis, as patients can report CRN intermittently, and the research has shown patients are not always persistent in CRN 17. In this analysis, the value of the age variable increases by 2 years for each respondent for each round of surveys from 2004 to 2014.…”

Section: Methodsmentioning

confidence: 94%

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Decreasing rates of cost-related medication non-adherence by age advancement among American generational cohorts 2004–2014: a longitudinal study

2022

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ObjectivesThe access barrier to medication has been a persistent and elusive challenge in the US healthcare system and around the globe. Cost-related medication non-adherence (CRN) is an important measure of medication non-adherence behaviours that aim to avoid costs. Longitudinal study of CRN behaviours for the ageing population is rare.DesignLongitudinal study using the Health and Retirement Study to evaluate self-reported CRN biennially.SettingGeneral population of older Americans.ParticipantsThree cohorts of Americans aged between 50 and 54 (baby boomers), 65–69 (the silent generation) and 80 or above (the greatest generation) in 2004 who were followed to 2014.InterventionObservational with no intervention.Primary and secondary outcome measuresLongitudinal CRN rates for three generational cohorts from 2004 to 2014. Population-averaged effects of a broad set of variables including sociodemographics, income, insurance status, limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and comorbid conditions on CRN were derived using generalised estimating equation by taking into account repeated measurements of CRN over time for the three cohorts, respectively.ResultsThe three cohorts of baby boomer, the silent generation and the greatest generation with 1925, 2839 and 2666 respondents represented 12.3 million, 8.2 million and 7.7 million people in 2004, respectively. Increasing age was associated with decreasing likelihood of reporting CRN in all three generational cohorts (p<0.05), controlling for demographics, income, insurance status, functional status and comorbid conditions. All three generational cohorts had a higher prevalence of diabetes, cancer, heart conditions, stroke, a higher percentage of respondents with Medicare-Medicaid dual eligibility and lower percentage with private insurance in 2014 compared with 2004 (p<0.05).ConclusionThe paradox of decreasing CRN rates, independent of disease burden, income and insurance status, suggests populations’ CRN behaviours change as Americans age, bearing implications to social policy.

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Section: Discussionsupporting

confidence: 82%

Section: Methodsmentioning

confidence: 94%

Decreasing rates of cost-related medication non-adherence by age advancement among American generational cohorts 2004–2014: a longitudinal study

2022

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“…Our findings are consistent with a study of Medicare beneficiaries without cancer, where worse self-reported health was found in those reporting cost-related medication nonadherence compared with those adherent. 43 The increased risk for ED visits and hospitalizations after report of cost-related medication nonadherence may reflect difficulties in comorbidity management, since 69% of survivors in our study reporting cost-related medication nonadherence had at least one other noncancer comorbidity compared with 56% who did not report nonadherence. Tools such as those included in geriatric assessment could be an ideal provider-level intervention to guide comorbidity management in older cancer survivors and potentially improve medication adherence, improve health, and decrease costs.…”

Section: Discussionmentioning

confidence: 69%

Cost-Related Medication Nonadherence and Patient Cost Responsibility for Rural and Urban Cancer Survivors

Williams

Davidoff

Halpern

et al. 2022

JCO Oncology Practice

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PURPOSE: The relationship between out-of-pocket spending and cost-related medication nonadherence among older rural- and urban-dwelling cancer survivors is not well understood. METHODS: This retrospective cohort study used the Surveillance, Epidemiology, and End Results Program, Medicare claims, and the Consumer Assessment of Healthcare Providers and Systems survey linked data resource linked data (2007-2015) to investigate the relationship between cancer survivors' cost responsibility in the year before and after report of delaying or not filling a prescription medication because of cost in the past 6 months (cost-related medication nonadherence). Secondary exposures and outcomes included Medicare spending and utilization. Generalized linear models assessed bidirectional relationships between cost-related medication nonadherence, spending, and utilization. Effects of residence were assessed via interaction terms. RESULTS: Of 6,591 older cancer survivors, 13% reported cost-related medication nonadherence. Survivors were a median 8 years (interquartile range, 4.5-12.5 years) from their cancer diagnosis, 15% were dually Medicare/Medicaid-eligible, and prostate (40%) and breast (32%) cancer survivors were most prevalent. With every $500 USD increase in patient cost responsibility, risk of cost-related medication nonadherence increased by 3% (risk ratio, 1.03; 95% CI, 1.02 to 1.04). After report of cost-related medication nonadherence, patient cost responsibility was 22% higher (95% CI, 1.11 to 1.32) compared with those not reporting nonadherence, amounting to $523 USD (95% CI, $430 USD to $630 USD). Medicare spending and utilization were also higher before and after report of cost-related nonadherence versus none. For survivors residing in rural (18%) and urban (82%) areas, residence did not modify adherence or cost outcomes. CONCLUSION: A bidirectional relationship exists between patient cost responsibility and cost-related medication nonadherence. Interventions reducing urban- and rural-dwelling survivor health care costs and cost-related adherence barriers are needed.

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“…We found that CRN was not associated with general health status and disability status for self-reported health outcomes. In comparison to other studies, De Avila et al reported a higher risk of persistent CRN was linked to worse self-reported health and depression (De Avila et al, 2021). Bambauer et al indicated that CRN was worsened by poor health among both older adults and beneficiaries with disabilities (Bambauer et al, 2007).…”

Section: Discussionmentioning

confidence: 92%

Cost-Related Medication Nonadherence (CRN) on Healthcare Utilization and Patient-Reported Outcomes: Considerations in Managing Medicare Beneficiaries on Antidepressants

Alnijadi

Yuan

et al. 2021

Front. Pharmacol.

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Background: Many patients face a financial burden due to their medications, which may lead to poor health outcomes. The behaviors of non-adherence due to financial difficulties, known as cost-related medication non-adherence (CRN), include taking smaller doses of drugs, skipping doses to make prescriptions last longer, or delaying prescriptions. To date, the prevalence of CRN remains unknown, and there are few studies about the association of CRN on self-reported healthcare utilization (Emergency room (ER) visits and outpatient visits) and self-reported health outcomes (health status and disability status) among older adults taking antidepressants.Objectives: The objectives were to 1) examine the CRN prevalence, and 2) determine the association of CRN on self-reported healthcare utilization and self-reported health outcomes.Methods: This study was a cross-sectional study of a sample of older adults from the Medicare Current Beneficiary Survey (MCBS) who reported having used antidepressants in 2017. Four logistic regressions were implemented to evaluate the association of CRN, and self-reported healthcare utilization and self-reported health outcomes.Results: The study identified 602 participants who were Medicare beneficiaries on antidepressants. The prevalence of CRN among antidepressant users was (16.61%). After controlling for covariates, CRN was associated with poorer self-reported outcomes but not statistically significant: general health status [odds ratio (OR): 0.67; 95% confidence interval (CI): 0.39–1.16] and disability status (OR: 1.34; 95% CI: 0.83–2.14). In addition, CRN was associated with increased outpatient visits (OR: 1.89; 95% CI: 1.19–3.02), but not associated with ER visits (OR: 1.10; 95% CI: 0.69–1.76).Conclusion: For Medicare beneficiaries on antidepressants, CRN prevalence was high and contributed to more outpatient visits. The healthcare provider needs to define the reasoning for CRN and provide solutions to reduce the financial burden on the affected patient. Also, health care providers need to consider the factors that may enhance patient health status and healthcare efficiency.

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Prevalence and Persistence of Cost-Related Medication Nonadherence Among Medicare Beneficiaries at High Risk of Hospitalization

Cited by 22 publications

References 38 publications

Decreasing rates of cost-related medication non-adherence by age advancement among American generational cohorts 2004–2014: a longitudinal study

Decreasing rates of cost-related medication non-adherence by age advancement among American generational cohorts 2004–2014: a longitudinal study

Cost-Related Medication Nonadherence and Patient Cost Responsibility for Rural and Urban Cancer Survivors

Cost-Related Medication Nonadherence (CRN) on Healthcare Utilization and Patient-Reported Outcomes: Considerations in Managing Medicare Beneficiaries on Antidepressants

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