Factors Affecting Prescribed Medication Compliance of the Urban Homeless Adult

Nyamathi, Adeline; Shuler, Pamela

doi:10.1097/00006205-198908000-00008

Cited by 18 publications

(18 citation statements)

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“…13 Several barriers to medication adherence exist in the homeless, including limited or no prescription insurance coverage, financial instability, lack of storage space for medications, limited privacy, and lack of transportation to pick up their medications. 14,15 Further, medication adherence may not be a primary concern to an individual who is homeless because of issues with meeting basic needs, such as obtaining food or housing. 15 …”

Section: Introductionmentioning

confidence: 99%

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Medication adherence challenges among patients experiencing homelessness in a behavioral health clinic

Coe

Moczygemba

Gatewood

et al. 2015

Research in Social and Administrative Pharmacy

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Background Behavioral health medication nonadherence is associated with poor health outcomes and increased healthcare costs. Little is known about reasons for nonadherence with behavioral health medications among homeless people. Objectives To identify reasons for medication nonadherence including the sociodemographic, health-related factors, and behavioral health conditions associated with medication nonadherence among behavioral health patients served by a Health Care for the Homeless center (HCH) in Virginia. Methods The study sample was selected from an existing database that included sociodemographic, health-related information, and medication-related problems identified during a pharmacist-provided medication review conducted during October 2008–September 2009. Patients experiencing or at risk of homelessness who were ≥ 18 years old with at least one behavioral health condition who had a medication review were eligible for the study. A qualitative content analysis of the pharmacist documentation describing the patient’s reason(s) for medication nonadherence was conducted. The Behavioral Model for Vulnerable Populations was the theoretical framework. The outcome variable was self-reported medication nonadherence. Descriptive and multivariate (logistic regression) statistics were used. Results A total of 426 individuals met study criteria. The mean age was 44.7 ± 10.2 years. Most patients were African-American (60.5%) and female (51.6%). The content analysis identified patient-related factors (74.8%), therapy-related factors (11.8%), and social or economic factors (8.8%) as the most common reasons for patients’ medication nonadherence. Patients with post-traumatic stress disorder (PTSD) (adjusted odds ratio: 0.4; 95% CI: 0.19–0.87) were less likely to have a medication adherence problem identified during the medication review. Conclusions The content analysis identified patient-related factors as the most common reason for nonadherence with behavioral health medications. In the quantitative analysis, patients with a PTSD diagnosis were less likely to have nonadherence identified which may be related to their reluctance to self-report nonadherence and their diagnosis, which warrants further study.

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Section: Introductionmentioning

confidence: 99%

“…14,15 Further, medication adherence may not be a primary concern to an individual who is homeless because of issues with meeting basic needs, such as obtaining food or housing. 15 …”

Section: Introductionmentioning

confidence: 99%

Medication adherence challenges among patients experiencing homelessness in a behavioral health clinic

Coe

Moczygemba

Gatewood

et al. 2015

Research in Social and Administrative Pharmacy

View full text Add to dashboard Cite

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“…Homeless individuals often have poor access to health care services and difficulty obtaining medications because of cost. 1,4,12,14 Therefore, that ineffective drug therapy and medication nonadherence were common problems is not surprising. A comprehensive medication assessment can identify these problems, and a model such as the CMTM/PCMH model described in this report can help resolve the problems in a timely manner.…”

Section: Discussionmentioning

confidence: 99%

“…Unstable living environments negatively affect their ability to maintain medication regimens and store medications. 12 Conditions common in homeless people, such as substance abuse and mental health disorders, are predictors of poor adherence to medication regimens. 11,13–16 Homelessness also has been reported to predict nonadherence to psychotropic, human immunodeficiency virus/acquired immunodeficiency syndrome, and tuberculosis drug regimens.…”

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confidence: 99%

Integration of collaborative medication therapy management in a safety net patient-centered medical home

Moczygemba¹,

Goode²,

Gatewood³

et al. 2011

Journal of the American Pharmacists Association

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Objective To describe the integration of collaborative medication therapy management (CMTM) into a safety net patient-centered medical home (PCMH). Setting Federally qualified Health Care for the Homeless clinic in Richmond, VA, from October 2008 to June 2010. Practice description A CMTM model was developed by pharmacists, physicians, nurse practitioners, and social workers and integrated with a PCMH. CMTM, as delivered, consisted of (1) medication assessment, (2) development of care plan, and (3) follow-up. Practice innovation CMTM is integrated with the medical and mental health clinics of PCMH in a safety net setting that serves homeless individuals. Main outcome measures Number of patients having a CMTM encounter, number and type of medication-related problems identified for a subset of patients in the mental health and medical clinics, pharmacist recommendations, and acceptance rate of pharmacist recommendations. Results Since October 2008, 695 patients have had a CMTM encounter. An analysis of 209 patients in the mental health clinic indicated that 425 medication-related problems were identified (2.0/patient). Pharmacists made 452 recommendations to resolve problems, and 384 (85%) pharmacist recommendations were accepted by providers and/or patients. For 40 patients in the medical clinic, 205 medication-related problems were identified (5.1/patient). Pharmacists made 217 recommendations to resolve the problems, and 194 (89%) recommendations were accepted. Conclusion Integrating CMTM with a safety net PCMH was a valuable patient-centered strategy for addressing medication-related problems among homeless individuals. The high acceptance rate of pharmacist recommendations demonstrates the successful integration of pharmacist services.

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“…They form an increasingly diverse group that includes growing numbers of women and families with children (Institute of Medicine, 1988). Their substandard living conditions and risk factors for poor health have been described in the literature (Grunberg & Eagle, 1990;Kline & Saperstein, 1992;Mason, Jensen, & Boland, 1992;Nyamathi & Shuler, 1989;Winkleby, 1990). The homeless present nurses and other health practitioners with particular challenges in providing health care and health education (Brickner, Scanlan, Conanan, Elvy, McAdam, Scharer, & Vicic, 1986;Institute of Medicine, 1988;Jackson & McSwane, 1992;Wlodarczyk & Prentice, 1988).…”

Section: The Homelessmentioning

confidence: 99%

Tuberculosis Health Education Needs in Homeless Shelters

Kitazawa

1995

Public Health Nursing

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Tuberculosis has reemerged as an important public health concern, particularly with the rise in multi-drug-resistant strains. The homeless are at increased risk for infection, for active disease, and for incomplete treatment. Public health authorities have recommended that tuberculosis health education materials be developed specifically for residents and staff of homeless shelters. In this study, a diverse sample of 20 adult homeless-shelter residents responded to open-ended questions regarding 1) their knowledge of tuberculosis and tuberculosis screening and treatment, 2) their perceptions of access to health care services related to tuberculosis, and 3) their views of health education regarding tuberculosis. The majority of the subjects had limited knowledge of tuberculosis and of screening and treatment for the disease. Many had misconceptions about the disease, particularly regarding its transmission. An analysis of the subjects' responses within the framework of the Health Belief Model indicated that basic tuberculosis health education programs for residents of homeless shelters are needed. The study findings indicated that a small-group educational format utilizing written materials and video aids might be most effective.

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Factors Affecting Prescribed Medication Compliance of the Urban Homeless Adult

Cited by 18 publications

References 0 publications

Medication adherence challenges among patients experiencing homelessness in a behavioral health clinic

Medication adherence challenges among patients experiencing homelessness in a behavioral health clinic

Integration of collaborative medication therapy management in a safety net patient-centered medical home

Tuberculosis Health Education Needs in Homeless Shelters

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