Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions

Abstract Medication non-adherence (MNA) constitutes a complex health problem contributing to increased economic burden and poor health outcomes. The Medication Adherence Model (MAM) supports that numerous processes are involved in medication adherence (MA). Based on the MAM and guidelines of the World Health Organization (WHO), this scoping review aimed to identify the barriers and facilitators associated with MA, and the behavioral health interventions and techniques among chronic conditions presenting with high non-adherence rates (asthma, cancer, diabetes, epilepsy, HIV/AIDS, and hypertension). PubMed, PsycINFO, and Scopus databases were screened, and 243 studies were included. A mixed methods approach was used to collate the evidence and interpret findings. The most commonly reported barriers to MA across conditions were younger age, low education, low income, high medication cost, side effects, patient beliefs/perceptions, comorbidities, and poor patient–provider communication. Additionally, digitally delivered interventions including components such as medication and condition education, motivational interviewing (MI), and reinforcement and motivational messages led to improvements in MA. This review highlights the importance of administrating multicomponent interventions digitally and personalized to the patients’ individual needs and characteristics, responding to the adherence barriers faced. This is the first review examining and synthesizing evidence on barriers and facilitators to MA and behavioral health interventions used for improving MA across chronic conditions with the highest non-adherence rates and providing recommendations to researchers and clinicians. Stakeholders are called to explore methods overcoming barriers identified and developing effective multicomponent interventions that can reduce the high rates of MNA.

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Multiple chronic conditions at a major urban health system: a retrospective cross-sectional analysis of frequencies, costs and comorbidity patterns

BMJ Open ◽

10.1136/bmjopen-2019-029340 ◽

2019 ◽

Vol 9 (10) ◽

pp. e029340 ◽

Cited By ~ 3

Author(s):

Usnish B Majumdar ◽

Christophe Hunt ◽

Patrick Doupe ◽

Aaron J Baum ◽

David J Heller ◽

...

Keyword(s):

New York ◽

Health System ◽

Urban Health ◽

Low Income ◽

Chronic Conditions ◽

Cross Sectional Study ◽

Multiple Chronic Conditions ◽

Cross Sectional ◽

Study Population ◽

Mount Sinai

ObjectiveTo (1) examine the burden of multiple chronic conditions (MCC) in an urban health system, and (2) propose a methodology to identify subpopulations of interest based on diagnosis groups and costs.DesignRetrospective cross-sectional study.SettingMount Sinai Health System, set in all five boroughs of New York City, USA.Participants192 085 adult (18+) plan members of capitated Medicaid contracts between the Healthfirst managed care organisation and the Mount Sinai Health System in the years 2012 to 2014.MethodsWe classified adults as having 0, 1, 2, 3, 4 or 5+ chronic conditions from a list of 69 chronic conditions. After summarising the demographics, geography and prevalence of MCC within this population, we then described groups of patients (segments) using a novel methodology: we combinatorially defined 18 768 potential segments of patients by a pair of chronic conditions, a sex and an age group, and then ranked segments by (1) frequency, (2) cost and (3) ratios of observed to expected frequencies of co-occurring chronic conditions. We then compiled pairs of conditions that occur more frequently together than otherwise expected.Results61.5% of the study population suffers from two or more chronic conditions. The most frequent dyad was hypertension and hyperlipidaemia (19%) and the most frequent triad was diabetes, hypertension and hyperlipidaemia (10%). Women aged 50 to 65 with hypertension and hyperlipidaemia were the leading cost segment in the study population. Costs and prevalence of MCC increase with number of conditions and age. The disease dyads associated with the largest observed/expected ratios were pulmonary disease and myocardial infarction. Inter-borough range MCC prevalence was 16%.ConclusionsIn this low-income, urban population, MCC is more prevalent (61%) than nationally (42%), motivating further research and intervention in this population. By identifying potential target populations in an interpretable manner, this segmenting methodology has utility for health services analysts.

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PIH66 ASSOCIATION BETWEEN MEDICATION BURDEN AND ADHD MEDICATION ADHERENCE IN A PEDIATRIC POPULATION WITH MULTIPLE CHRONIC CONDITIONS

Value in Health ◽

10.1016/j.jval.2020.04.460 ◽

2020 ◽

Vol 23 ◽

pp. S164

Author(s):

C. Yan ◽

K. Zhang ◽

R.L. Harrington ◽

T.A. Lee

Keyword(s):

Medication Adherence ◽

Chronic Conditions ◽

Pediatric Population ◽

Multiple Chronic Conditions ◽

Adhd Medication

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Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review

Journal of Advanced Nursing ◽

10.1111/j.1365-2648.2008.04656.x ◽

2008 ◽

Vol 63 (2) ◽

pp. 132-143 ◽

Cited By ~ 118

Author(s):

Allison Williams ◽

Elizabeth Manias ◽

Rowan Walker

Keyword(s):

Systematic Review ◽

Medication Adherence ◽

Chronic Conditions ◽

Multiple Chronic Conditions ◽

Improve Medication Adherence

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Do Medical Homes Increase Medication Adherence for Persons With Multiple Chronic Conditions?

Medical Care ◽

10.1097/mlr.0000000000000292 ◽

2015 ◽

Vol 53 (2) ◽

pp. 168-176 ◽

Cited By ~ 17

Author(s):

Christopher A. Beadles ◽

Joel F. Farley ◽

Alan R. Ellis ◽

Jesse C. Lichstein ◽

Joseph P. Morrissey ◽

...

Keyword(s):

Medication Adherence ◽

Chronic Conditions ◽

Multiple Chronic Conditions ◽

Medical Homes

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Emergency Department and Inpatient Utilization among U.S. Older Adults with Multiple Chronic Conditions: A Post-Reform Update

10.21203/rs.2.10545/v3 ◽

2020 ◽

Author(s):

SangNam Ahn ◽

Mustafa Hussein ◽

Asos Mahmood ◽

Matthew Lee Smith

Keyword(s):

Older Adults ◽

Emergency Department ◽

Low Income ◽

Chronic Conditions ◽

Medical Expenditure Panel Survey ◽

Medical Expenditure ◽

Multiple Chronic Conditions ◽

Medicare Beneficiaries ◽

Percentage Points ◽

Ed Visits

Abstract Background. The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update. Methods. We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015). Results. Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals [CI]: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points [95%CI: -2.9, 0.2, p < 0.1], after multivariable adjustment. Conclusions. We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.

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Changes in chronic disease medication adherence following oral anticancer agent initiation in patients with multiple myeloma.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18760 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18760-e18760

Author(s):

Justin Gatwood ◽

Ankur Dashputre ◽

Alex Wallace ◽

Katie S. Gatwood ◽

Karen B. Farris ◽

...

Keyword(s):

Multiple Myeloma ◽

Chronic Disease ◽

Medication Adherence ◽

Chronic Conditions ◽

Anticancer Agent ◽

Survival Rates ◽

Multiple Chronic Conditions ◽

First Year ◽

Total N ◽

Before And After

e18760 Background: Improvements in treatment options for multiple myeloma (MM) have led to double-digit increases in 5-year survival rates over the past 40 years. Such extended survival has increased emphasis for the management of comorbid chronic conditions. Initial analyses suggest that oral anticancer agent (OAA) initiation for MM may correspond to significant reductions in adherence to chronic disease medications. Methods: This was a retrospective cohort study of adults diagnosed with and being treated for MM between 2013-2018 using data from the IBM MarketScan Commercial Claims and Encounters databases and a 20% sample of Medicare claims data. Adults (18 years and older) were included if they were diagnosed with and had at least two claims for an OAA indicated for MM, had continuous enrollment for 12 months both before and after OAA initiation, and were previously diagnosed with two chronic conditions and had prescription fills for select chronic conditions. Medication adherence was determined using the proportion of days covered (PDC) metric and was compared for the 12 months before and after the OAA initiation by Wilcoxon signed-rank tests, McNemar’s tests, and difference-in-differences (DinD) models. Results: A slight majority of the 2,765 patients (total N from both databases) were male (52.3%), and hypertension (94.5%) and hyperlipidemia (69.2%) were the most common comorbid conditions. Mean OAA adherence in the first year of therapy was 55.8% (SD: 23.5) and 63.5% (SD: 26.9) for commercial and Medicare patients, respectively. PDCs for comorbid therapies declined in the first year after OAA initiation, irrespective of payer (table), and the proportion adherent to these therapies (PDC > 80%) also declined consistently. OAA adherence tended to align with the direction of changes in comorbid therapy adherence with those nonadherent to their OAA (PDC < 80%) demonstrating general declines in comorbid therapy PDCs post-OAA initiation (p<0.05 in 4 of 6 DinD models). Conclusions: Among adults with MM and multiple chronic conditions, the pre-OAA initiation level of adherence appears to dictate chronic disease medication use patterns after OAA initiation. The starting of OAA therapy facilitates an opportunity for providers to reinforce the need for total regimen adherence to improve the odds of positive cancer- and non-cancer-related outcomes. [Table: see text]

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Chronic disease and socioeconomic factors among uninsured patients: A retrospective study

Chronic Illness ◽

10.1177/1742395319828430 ◽

2019 ◽

pp. 174239531982843 ◽

Cited By ~ 1

Author(s):

Shams Rahman ◽

Abu-Sayeef Mirza ◽

Deanna Wathington ◽

Shikerria Green ◽

Yeshuwa Mayers ◽

...

Keyword(s):

Low Income ◽

Chronic Conditions ◽

Older Patients ◽

Chronic Obstructive ◽

Free Clinics ◽

Health Care Needs ◽

Care Needs ◽

Uninsured Patients ◽

Obstructive Pulmonary Disease ◽

Artery Disease

Objectives Uninsured patients represent an understudied population. The current study aimed to estimate the burden of 10 common chronic conditions and to investigate the associated factors among patients who use free clinics for their health care needs. Methods Patient charts from four free clinics were reviewed from January to December of 2015. Proportion of prevalence, adjusted odds ratios (AOR), and 95% confidence intervals (CI) for associations between participant characteristics and chronic conditions are reported. Results Prevalence of hypertension and hyperlipidemia significantly differed by clinic, age, gender, race, and marital status. Compared to age 15–44 years, older patients (45–64 years, and ≥65) were 5–10 times more likely to suffer from hypertension. Compared to women, men; compared to White, African-Americans; and compared to single, married patients had higher prevalences of hypertension. Older patients were 5–8 times more likely to suffer from hyperlipidemia. Asians, and married patients were also more likely to experience hyperlipidemia. Prevalence of diabetes, depression and arthritis significantly differed by age and race. Prevalence of coronary artery disease and chronic obstructive pulmonary disease increased 6–13 folds among older patients. Discussion Patients of free clinics suffer from high burden of chronic conditions. Patients who frequent free clinics are primarily older, unemployed, women, minorities, and are of low income.

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Emergency Department and Inpatient Utilization among U.S. Older Adults with Multiple Chronic Conditions: A Post-Reform Update

10.21203/rs.2.10545/v1 ◽

2019 ◽

Author(s):

SangNam Ahn ◽

Mustafa Hussein ◽

Asos Mahmood ◽

Matthew Lee Smith

Keyword(s):

Older Adults ◽

Emergency Department ◽

Low Income ◽

Chronic Conditions ◽

Medical Expenditure Panel Survey ◽

Medical Expenditure ◽

Multiple Chronic Conditions ◽

Medicare Beneficiaries ◽

Percentage Points ◽

Ed Visits

Abstract Background The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update. Methods We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using survey-weighted logistic regression, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015). Results Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals [CI]: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points [95%CI: -2.9, 0.2, p < 0.1], after multivariable adjustment. Conclusions We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.

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