Costs and beliefs: Understanding individual- and neighborhood-level correlates of medication nonadherence among Mexican Americans with type 2 diabetes.

Abstract

Objective High rates of medication nonadherence observed in disadvantaged populations are often attributed to socioeconomic factors. Little is known, however, about how a person’s neighborhood environment may contribute to nonadherence beyond what can be explained by a lack of individual resources to pay for medications. This study considered the reasons patients reported for deviating from their medication regimens to understand how individual-level and neighborhood-level indicators of socioeconomic status (SES) may each influence adherence behavior. Method Cross-sectional data were collected between 2006 and 2011 from a sample of Mexican American patients with type 2 diabetes (N = 749) treated at university-affiliated clinics in Southern California. Measures included individual-level SES (years of education, health insurance type, and household income), neighborhood deprivation, and medication nonadherence (for reasons related to cost and reasons related to beliefs about medications). Neighborhood deprivation was assessed using the Neighborhood Socioeconomic Status Index (Dubowitz et al., 2011), a validated aggregate of census tract-level indicators linked to each participant’s home address. Results Results from multilevel logistic regression models revealed that individual-level SES was associated with nonadherence related to cost (annual household income < $20,000 vs. > $40,000, p = .001; Medicare vs. commercial health insurance, p < .001), whereas neighborhood deprivation was associated with nonadherence related to beliefs about medications (p = .011). Conclusion Findings from this study suggest that an individual’s lack of resources may contribute to nonadherence related to cost, whereas elements of the broader social environment may promote nonadherence related to negative beliefs about medications.

Neighborhood Social Environment and Patterns of Adherence to Oral Hypoglycemic Agents Among Patients With Type 2 Diabetes Mellitus

“…Their findings suggest that social environment as well as related costs may contribute to nonadherence. 24 In our work we enrolled patients who already had filled prescriptions for oral hypoglycemic agents and we adjusted for individual financial status, thus minimizing the influence of cost on adherence to medication regimens, and supporting evidence that neighborhood social environment and adherence may be linked by factors other than financial pressure. Our work is further delineated from prior work by a focus on features of neighborhood social environment derived from the work of Sampson et al 18-20 Our findings provide insight into the social mechanisms and process that link neighborhood environment to health.…”

“…Prior work has found that neighborhood residence is associated with medication adherence 13,24,25 and other self-care behaviors, 26-28 even when controlling for individual characteristics. However, these studies have been limited by their cross-sectional designs, reliance on subjective adherence assessments and/or lack of a representative sampling frame due to regional variations in culture, context and available resources.…”

Understanding Disparities in Lipid Management Among Patients with Type 2 Diabetes: Gender Differences in Medication Nonadherence after Treatment Intensification

“…This study employed secondary analysis of a dataset with a number of strengths, including a diverse sample, the availability of a patient-reported measure of both the extent of and reasons for nonadherence (Billimek & August, 2013), and the assessment of regimen intensity from medical records for a period immediately preceding the collection of patient-reported measures. The dataset also has some important limitations.…”

“…Nonadherence related to side effects was measured as a composite of four items asking how frequently respondents deviated from their physicians' instructions due to side effects or other negative experiences with the medication. Each of these composite scales was scored as dichotomous variables, with patients reporting nonadherence on at least one item coded as “reporting nonadherence” (1), and those reporting no deviations from their prescribed regimen “not reporting nonadherence” (0; Billimek & August, 2013). …”

A theoretical model of how neighborhood factors contribute to medication nonadherence among disadvantaged chronically ill adults

“…Cost-related nonadherence is particularly problematic for patients from disadvantaged minority populations (Gellad et al, 2007;Tseng et al, 2008) and is associated with a number of deleterious consequences, such as increased emergency department visits, decreased health status, and even mortality (Heisler et al, 2004;Piette et al, 2004aSteinman et al, 2001. The idea that individual-level income and insurance status are associated with nonadherence related to cost has been reported in numerous studies (Billimek and August, 2014;Briesacher et al, 2007;Piette et al, 2004a) and speaks to the challenges that patients with limited resources face to pay for prescriptions. Some evidence indicates that even with insurance coverage, low-income patients with chronic conditions report having trouble paying the costs associated with their condition (Billimek and Sorkin, 2012a;Gellad et al, 2007;Goldman and Epstein, 2011;Ngo-Metzger et al, 2012) and continue to experience poor outcomes in spite of increased health care utilization (Baicker et al, 2013).…”