Cost-related medication underuse: Strategies to improve medication adherence at care transitions

Miranda, Aimon; Serag-Bolos, Erini S.; Cooper, Julie

doi:10.1093/ajhp/zxz010

Cited by 11 publications

(9 citation statements)

References 47 publications

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“…Readmission due to lack of access to drugs because of cost was also frequent in this cohort (11.9%), a problem increasingly in the spotlight due to the rising cost of prescription medications, but this outcome is also easily influenced by health system programs providing access to medications at discharge, like bedside discharge medication delivery. 18 Among MRP named in our study, physicians' least frequently defined problems of safety, but 14 out of 19 (73.7%) of these MRP were rated as potentially preventable. Problems of adherence were also less frequently identified in the overall cohort and less than half (46.4%) were rated as possibly preventable.…”

Section: Discussionmentioning

confidence: 72%

Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital

Cooper

Jeter

Sessoms

2019

Journal of Pharmacy Technology

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Background: Impact of medication-related problems (MRPs) on persistently high hospital readmission rates are not well described. Objective: The purpose of this study was to determine the rate and type of MRPs attributed to rehospitalization within 30 days of discharge from a general internal medicine hospitalists’ service at a nonacademic medical center. Methods: A retrospective cohort study was conducted evaluating consecutive patients readmitted within 30-days after discharge to home from an internal medicine hospitalist service. Readmissions attributed to MRPs in physician documentation were systematically classified as indication, effectiveness, adverse drug reaction, or nonadherence problems and evaluated for possible preventability. Descriptive statistics were used to describe the rate and type of MRP. Results: Evaluation of consecutive 30-day readmissions (n = 203) to a nonteaching community hospital identified 50.2% of admissions attributed to MRPs. MRPs (n = 102) were categorized as problems of indication (34.3%), efficacy (19.6%), adverse drug events (18.6%), and nonadherence (27.5%). One third of 30-day readmissions in this cohort were attributed to potentially preventable MRPs. Conclusion: MRPs are frequently implicated in 30-day hospital readmissions in a nonteaching community hospital representing an opportunity for context-specific improvements.

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Section: Discussionmentioning

confidence: 72%

Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital

Cooper

Jeter

Sessoms

2019

Journal of Pharmacy Technology

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“…In fact, 29% of our sample reported incomes above the federal poverty line, and 38% of the entire HER Salt Lake cohort reported incomes between 101–300% FPL [ 10 ]. It is widely recognized that healthcare, and prescription drugs specifically, is prohibitively expensive for many Americans [ 11 – 13 ]; this may explain why we did not see hypothesized differences in method selection when comparing our subset of participants reporting to the larger enrolled population during either study period. This finding also adds to the existing body of literature indicating that reducing cost barriers helps to ameliorate healthcare disparities [ 14 ].…”

Section: Discussionmentioning

confidence: 89%

Does access to no-cost contraception change method selection among individuals who report difficulty paying for health-related care?

et al. 2022

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Background Out-of-pocket costs continue to be a barrier to accessing necessary healthcare services, including contraception. We explored how eliminating out-of-pocket cost affects contraceptive method choice among people reporting difficulty paying for healthcare in the previous year, and whether method satisfaction differed by method choice. Methods We used data from the HER Salt Lake Contraceptive Initiative. This prospective cohort study provided participants with no-cost contraception (April 2016–March 2017) following a control period that provided no reduction in cost for the contraceptive implant, a reduced price for the hormonal IUD, and a sliding scale that decreased to no-cost for the copper IUD (September 2015–March 2016). We restricted the study population to those who reported difficulty paying for healthcare in the past 12 months. For our primary outcome assessing changes in method selection between intervention and control periods, we ran simultaneous multivariable logistic regression models for each method, applying test corrections for multiple comparisons. Among participants who continued their method for 1 year, we explored differences in method satisfaction using multivariable logistic regression. Results Of the 1,029 participants reporting difficulty paying for healthcare and controlling for other factors, participants more frequently selected the implant (aOR 6.0, 95% CI 2.7, 13.2) and the hormonal IUD (aOR 3.2, 95% CI 1.7, 5.9) during the intervention than control period. Comparing the same periods, participants less frequently chose the injection (aOR 0.5, 95% CI 0.3, 0.8) and the pill (aOR 0.4, 95% CI 0.3, 0.6). We did not observe a difference in uptake of the copper IUD (aOR 2.0, 95% CI 1.0, 4.1).Contraceptive satisfaction scores differed minimally by contraceptive method used among contraceptive continuers (n = 534). Those who selected LNG IUDs were less likely to report low satisfaction with their method (aOR 0.5, 95% CI 0.3, 0.97). Conclusion With costs removed, participants who reported difficulty paying for healthcare were more likely to select hormonal IUDs and implants and less likely to select the injectable or contraceptive pills. Among continuers, there were few differences in method satisfaction. ClinicalTrials.gov Identifier NCT02734199

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“… 5 , 6 It is estimated that 20–30% of diabetes- and hypertension-related prescriptions are never filled. 7 , 8 Not taking medications as prescribed can worsen chronic conditions 3 , 9 and increase emergency room visits and hospitalizations. 10 , 11 Low-income patients are disproportionately affected by costs, especially when uninsured or underinsured.…”

Section: Introductionmentioning

confidence: 99%

Health informatics interventions to minimize out-of-pocket medication costs for patients: what providers want

et al. 2022

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Objective To explore diverse provider perspectives on: strategies for addressing patient medication cost barriers; patient medication cost information gaps; current medication cost-related informatics tools; and design features for future tool development. Materials and Methods We conducted 38 semistructured interviews with providers (physicians, nurses, pharmacists, social workers, and administrators) in a Midwestern health system in the United States. We used 3 rounds of qualitative coding to identify themes. Results Providers lacked access to information about: patients’ ability to pay for medications; true costs of full medication regimens; and cost impacts of patient insurance changes. Some providers said that while existing cost-related tools were helpful, they contained unclear insurance information and several questioned the information’s quality. Cost-related information was not available to everyone who needed it and was not always available when needed. Fragmentation of information across sources made cost-alleviation information difficult to access. Providers desired future tools to compare medication costs more directly; provide quick references on costs to facilitate clinical conversations; streamline medication resource referrals; and provide centrally accessible visual summaries of patient affordability challenges. Discussion These findings can inform the next generation of informatics tools for minimizing patients’ out-of-pocket costs. Future tools should support the work of a wider range of providers and situations and use cases than current tools do. Such tools would have the potential to improve prescribing decisions and better link patients to resources. Conclusion Results identified opportunities to fill multidisciplinary providers’ information gaps and ways in which new tools could better support medication affordability for patients.

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Cost-related medication underuse: Strategies to improve medication adherence at care transitions

Cited by 11 publications

References 47 publications

Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital

Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital

Does access to no-cost contraception change method selection among individuals who report difficulty paying for health-related care?

Health informatics interventions to minimize out-of-pocket medication costs for patients: what providers want

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