Racial Disparities in Quality of Medication Use in Older Adults: Findings From a Longitudinal Study

Abstract

BACKGROUND The quality of medication use in older adults is suboptimal with a large percentage of individuals not receiving recommended care. Most efforts to evaluate the quality of medication use target high-risk drugs, appropriate treatment of prevalent chronic disease states, or a set of predefined quality indicators of medication use, rather than the patient. It is also suggested that racial differences in the quality of medication use may exist in older adults. OBJECTIVE To determine the prevalence, number, and types of medication-related problems in older adults, examining the impact of race on quality medication use. METHODS A prospective cohort study involving in-home interviews and medical record reviews of 200 community-residing older adults stratified by race (100 blacks, 100 whites) conducted three times over 1 year. No intervention to address medication-related problems was performed. The quality of medication use was reported as medication-related problems by clinical pharmacists. KEY RESULTS Mean age was 78.3 (whites) and 75.5 (blacks), with the majority being female. Although whites used more medications than blacks (11.6 versus 9.7; p < 0.01), blacks had more medication-related problems per person than whites (6.2 versus 4.9; p < 0.01). All patients had at least one medication-related problem; common problems at baseline, 6 months, and 12 months for both whites and blacks were undertreatment, suboptimal drug use, suboptimal dosing, nonadherence, and less costly alternative available. Blacks had significantly higher rates of nonadherence than whites (68% versus 42%; p < 0.01). Over the 12-month study, the number of medication-related problems not only persisted but increased (adjusted p=0.0168). CONCLUSIONS Medication-related problems are prevalent in both black and white older adults and persist over one-year. Blacks had more medication-related problems than whites, including higher rates of nonadherence. These findings require further study to better understand racial disparities in the quality of medication use in older adults and the impact of race on specific medication-related problems.

Predictors of Long‐term Adherence to Evidence‐based Cardiovascular Disease Medications in Outpatients With Stable Atherothrombotic Disease: Findings From the REACH Registry

“…Another possible explanation is that certain racial/ethnic status may be linked with lower understanding of the benefits of continued medication adherence. A study by Roth and colleagues found that black and Hispanic patients had significantly higher rates of medication‐related problems and overall higher rates of nonadherence . Adverse cultural beliefs about the perceived benefits of medications and poor provider‐patient relationships have also been cited as reasons for reduced medication adherence among certain patient groups …”

“…A study by Roth and colleagues found that black and Hispanic patients had significantly higher rates of medication-related problems and overall higher rates of nonadherence. 28 Adverse cultural beliefs about the perceived benefits of medications and poor provider-patient relationships have also been cited as reasons for reduced medication adherence among certain patient groups. 5,29,30 Interestingly, we found a strong association between incident CV events and long-term adherence.…”

Medication adherence part two: Predictors of nonadherence and adherence

“…Inconsistent findings are reported for the effects of gender on adherence (Arlt et al., ; Cohen, Rogers, Burke, & Beilin, ; Gehi, Ali, Na, & Whooley, ; Hawthorne et al., ). Similarly, patient race/ethnicity appears to have a variable effect on adherence and persistence with medication regimens, with some studies reporting higher adherence rate among whites compared with blacks (Arlt et al., ; Doggrell, ; Gehi et al., ; Krousel‐Wood et al., ; Roth et al., ; Vik et al., ). Low health literacy and lower levels of educational attainment are associated with decreased adherence and persistence with pharmacotherapy (Arlt et al., ; Bosworth et al., ; Doggrell, ; Gehi et al., ; Gellad et al., ; Katz et al., ; Keller et al., ).…”

Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: A provider and patient perspective

“…21 These patients tend to be less compliant with treatment regimens, have delayed presentations and greater durations of stay, and lack resources and social support. [22][23][24][25][26] All of these factors may pose additional challenges to effective implementation of an ERAS pathway at a safety-net hospital.…”