Reduced Medication Access

Levine, Deborah A.; Kiefe, Catarina I.; Howard, George; Howard, Virginia J.; Williams, O. Dale; Allison, Jeroan J.

doi:10.1161/strokeaha.106.478545

Cited by 38 publications

(23 citation statements)

References 39 publications

(27 reference statements)

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“…15 In the study of regional differences in medication access, black women but not black men were more likely to be unable to afford medications after adjustment for income and insurance, possibly due to ef- Table 3 Odds ratios (95% confidence intervals) for access to physician care and medications, by age group, Mexican American and nonHispanic black vs non-Hispanic white, unadjusted, adjusted for all covariates except health insurance, and fully adjusted: National fect modification by gender and age. 14 Our finding of a nonsignificant 1.45 greater odds in adjusted inability to afford medications for blacks vs whites, in the present study, may be due to decreased power or may reflect a true attenuation of the association between being black and inability to afford medications by demographics and comorbidity. Demographics and comorbidity and also health insurance explained some but not all of the difference in inability to afford medications between Mexican Americans and whites.…”

Section: Discussioncontrasting

confidence: 68%

Racial/ethnic disparities in access to physician care and medications among US stroke survivors

et al. 2011

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Section: Discussioncontrasting

confidence: 68%

Racial/ethnic disparities in access to physician care and medications among US stroke survivors

et al. 2011

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“…In a study of 5840 stroke survivors as part of the National Health Interview Survey, researchers found that women, blacks or African Americans, and the poor were significantly less likely to fill prescriptions because of cost. 159 One report suggests that blacks or African Americans are less likely to have thorough diagnostic evaluations after a first stroke and are less likely to receive guideline-concordant stroke preventive medication. 160 In another study, which used the 2005 BRFSS in 11 862 stroke survivors, little difference was found among blacks or African Americans and nonHispanic whites with respect to secondary prevention measures.…”

Section: Disparities In Access To Stroke Prevention Servicesmentioning

confidence: 99%

Racial-Ethnic Disparities in Stroke Care: The American Experience

Cruz‐Flores¹,

Rabinstein²,

Biller³

et al. 2011

Stroke

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423

261

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Purpose-Our goal is to describe the effect of race and ethnicity on stroke epidemiology, personal beliefs, access to care, response to treatment, and participation in clinical research. In addition, we seek to determine the state of knowledge on the main factors that may explain disparities in stroke care, with the goal of identifying gaps in knowledge to guide future research. The intended audience includes physicians, nurses, other healthcare professionals, and policy makers. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council Scientific Statement Oversight Committee and represent different areas of expertise in relation to racial-ethnic disparities in stroke care. The writing group reviewed the relevant literature, with an emphasis on reports published since 1972. The statement was approved by the writing group; the statement underwent peer review, then was approved by the American Heart Association Science Advisory and Coordinating Committee. Results-There are limitations in the definitions of racial and ethnic categories currently in use. For the purpose of this statement, we used the racial categories defined by the US federal government: white, black or African American, Asian, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander. There are 2 ethnic categories: people of Hispanic/Latino origin or not of Hispanic/Latino origin. There are differences in the distribution of the burden of risk factors, stroke incidence and prevalence, and stroke mortality among different racial and ethnic groups. In addition, there are disparities in stroke care between minority groups compared with whites. These disparities include lack of awareness of stroke symptoms and signs and lack of knowledge about the need for urgent treatment and the causal role of risk factors. There are also differences in attitudes, beliefs, and compliance among minorities compared with whites. Differences in socioeconomic status and insurance coverage, mistrust of the healthcare system, the relatively limitedThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on April 6, 2011. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@woltersklu...

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“…Furthermore, uninsured patients are more likely to be unable to afford secondary stroke prevention medications once discharged. 12 Most of the preceding reasons for poorer outcomes are manifested outside of the acute hospital setting, and most physicians would agree that the care provided for each and every patient with stroke is the same regardless of socioeconomic or insurance status. However, most concerning about the present study is the statistically higher rates of patient safety events for those without private insurance while in the hospital, as well as the higher in-hospital mortality, longer lengths of stay, and worse outcomes based on discharge disposition, even after controlling for important variables such as comorbidities and race.…”

Section: 19mentioning

confidence: 99%

Health disparities and stroke: the influence of insurance status on the prevalence of patient safety indicators and hospital-acquired conditions

Fargen¹,

Neal²,

Blackburn³

et al. 2015

JNS

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OBJECT The Agency for Healthcare Research and Quality patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are publicly reported quality metrics linked directly to reimbursement. The occurrence of PSIs and HACs is associated with increased mortality and hospital costs after stroke. The relationship between insurance status and PSI and HAC rates in hospitalized patients treated for acute ischemic stroke was determined using the Nationwide Inpatient Sample (NIS) database. METHODS The NIS was queried for all hospitalizations involving acute ischemic stroke between 2002 and 2011. The rate of each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The SAS statistical software package was used to calculate rates and perform multivariable analyses to determine the effects of patient variables on the probability of developing each indicator. RESULTS The NIS query revealed 1,507,336 separate patient admissions that had information on both primary payer and hospital teaching status. There were 227,676 PSIs (15.1% of admissions) and 42,841 HACs reported (2.8%). Patient safety indicators occurred more frequently in Medicaid/self-pay/no-charge patients (19.1%) and Medicare patients (15.0%) than in those with private insurance (13.6%; p < 0.0001). In a multivariable analysis, Medicaid, self-pay, or nocharge patients had significantly longer hospital stays, higher mortality, and worse outcomes than those with private insurance (p < 0.0001). CONCLUSIONS Insurance status is an independent predictor of patient safety events after stroke. Private insurance is associated with lower mortality, shorter lengths of stay, and improved clinical outcomes.

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Reduced Medication Access

Abstract: Background and Purpose-Medication access is crucial to secondary stroke prevention. We assessed medication access and associated barriers to care across region and time in a national sample of US stroke survivors. Methods-Among

Cited by 38 publications

References 39 publications

Racial/ethnic disparities in access to physician care and medications among US stroke survivors

Racial/ethnic disparities in access to physician care and medications among US stroke survivors

Racial-Ethnic Disparities in Stroke Care: The American Experience

Health disparities and stroke: the influence of insurance status on the prevalence of patient safety indicators and hospital-acquired conditions

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