Risk for Cost‐related Medication Nonadherence Among Emergency Department Patients

Abstract

Objectives: There has been a rapid rise in prescription drug costs over the past decade. As a result, many Americans are unable to afford their medications, especially in the current economic recession. Medication nonadherence is known to have adverse effects on health outcomes. The purpose of this study was to gain a preliminary understanding of cost-related medication nonadherence (CRMN) disclosure among screened emergency department (ED) patients and to describe the extent to which CRMN is associated with other economic and psychosocial risk factors.Methods: This was a prospective, cross-sectional study of a convenience sample of adult patients presenting to an urban academic ED with 61,962 annual visits in 2009. Nonemergent patients received an optional self-administered Social Health Survey between May and October 2009. Results were assessed from the sample of anonymous surveys that were completed and collected. Standard statistical methods were used to determine the frequencies and relative risks (RRs) for CRMN with 95% confidence intervals (CIs).Results: A total of 384 (25.5%) of the 1,506 adult patients who completed the survey either screened positive for any prior CRMN (20.7%) or disclosed concerns about affording medication (4.8%). Patients were significantly more likely to report risk for CRMN if they used tobacco (RR = 1.8, 95% CI = 1.5 to 2.2) or illicit drugs (RR = 2.0, 95% CI = 1.6 to 2.4), experienced intimate partner violence (IPV; RR = 1.8, 95% CI = 1.5 to 2.2), or reported concerns about overall financial instability (RR = 3.9, 95% CI = 3.2 to 4.7), food insufficiency (RR = 3.7, 95% CI = 3.1 to 4.3), housing problems (RR = 2.5, 95% CI = 2.1 to 2.9), and inadequate health insurance coverage (RR = 7.7, 95% CI = 6.2 to 9.5).Conclusions: Risk for medication nonadherence due to cost concerns was identified in a quarter of nonemergent urban ED patients in our sample and was more likely to be reported by patients experiencing other economic and psychosocial risks. These findings indicate a need to include discussions about medication affordability and referrals to social services as part of ED discharge planning.

Material Needs of Emergency Department Patients: A Systematic Review

“…As would be expected, most studies excluded patients who were critically ill, intoxicated, or otherwise unable to provide informed consent and therefore may not be generalizable to the entire spectrum of ED patients. Response rates were generally above 50%, but two studies had response rates below 50% and several studies did not report response rates …”

“…Housing quality was studied infrequently. The few studies that examined housing quality found high percentages (18%–35.9%) of patients who were concerned about the physical quality of their housing (e.g., pests, structural problems), and Mazer et al . found that housing problems were associated with cost‐related medication nonadherence.…”

“…Homelessness among ED patients in Veterans Health Administration (VHA) facilities nationally has been reported at over 5%, compared to only 0.8% screening positive for homelessness in VHA outpatient clinics . Prior studies have also found high rates of food insecurity among ED patients . Despite the importance of material needs in the ED patient population, there has not yet been a systematic review of studies examining these needs among ED patients.…”

The Relationship Between Emergency Department Use and Cost-Related Medication Nonadherence Among Medicare Beneficiaries

“…For example, although some individuals are automatically enrolled in the LIS Part D program (including dual eligibles, persons in Medicare Savings Programs and Social Security Income recipients), an estimated 2 million individuals do not receive this benefit despite being eligible, mainly due to lack of awareness of eligibility and enrollment procedures. 49 Other seniors may qualify for SPAP, which is also means tested and offers premium and copayment assistance for Part D plan participation in a number of states. 50 Finally, as we do not have charges or costs associated with each visit in our dataset, it is unclear how our findings translate into additional costs for the ED population.…”

Gender differences in cost-related medication non-adherence among cancer survivors

“…Based on the Andersen's Health Care Utilization Model, we chose 12 variables as possible factors affecting gender differences in CRN [23][24][25]. These 12 variables from three domains (predisposing factors, enabling factors, and need factors) are known to be robustly linked to CRN in a number of previous studies [26][27][28][29].…”