A PILOT STUDY ON COST-RELATED MEDICATION NONADHERENCE IN ONTARIO

Main Article Content

Bo Zheng
Alice Poulose
Martha Fulford
Anne Holbrook

Keywords

Prescription medication costs, adherence, survey, internal medicine clinic, Ontario

Abstract

Background


Cost-related nonadherence (CRN) describes patients cutting back on their prescribed medication due to an inability to pay. CRN is influenced by drug insurance coverage plans, which vary widely among different healthcare systems. Little is known about CRN in Canada and Ontario.


 


Objective


To develop and pilot a questionnaire about CRN.


 


Methods


An interviewer-administered questionnaire assessing demographics, socioeconomic status, health status and health literacy, medication costs and CRN was developed for this pilot study. Participants were recruited from a general internal medicine rapid assessment outpatient clinic of a large urban teaching hospital.


 


Results


Sixty patients were recruited (mean age 60.3 years; 48.3% female; mean of 5.3 prescription medications per patient). Nine patients (15%) reported some form of CRN. Unfilled prescriptions, delayed prescriptions, less frequent and smaller doses were the most common forms of CRN. Seven patients (11.7%) had no drug insurance. Patients without drug insurance were more likely to experience CRN than patients with private insurance (OR 20.70, 95% CI 1.46-292.75); government coverage also increased the likelihood of CRN compared to private coverage (OR 4.51, 95% CI 0.376-54.11). Patients spending over $100 a month out-of-pocket were more likely to experience CRN than patients spending less than $20 (OR 42.52, 95% CI 2.02-894.03). Thirty-three patients (55%) said that their physicians had not asked them about how they deal with the cost of prescriptions.


 


Conclusion


Based on our pilot survey, a significant minority of specialty clinic outpatients experience CRN and prescribers frequently forget to inquire whether patients can afford their medications.

Abstract 216 | PDF Downloads 91

References

1. Piette JD, Heisler M, Robert H, Alexander C. A conceptually based approach to understanding chronically ill patients’ responses to medication cost pressures. Social Science & Medicine 2006;62: 846-57.
2. Kennedy J, Morgan S. Cost-related prescription nonadherence in the United States and Canada: A system-level comparison using the 2007 International Health Policy Survey in seven countries. Clinical Therapeutics 2009;31(1):213-9.
3. Kirking DM, Lee JA, Ellis JJ, Briesacher B, Mckercher PL. Patient-reported underuse of prescription medications: A comparison of nine surveys. Medical Care Research and Review 2006;63:427-46.
4. Piette JD, Heisler M, Wagner TH. Cost-related medication underuse among chronically ill adults: The treatments people forgo, how often, and who is at risk. American Journal of Public Health 2004; 94(10):1782-7.
5. Simpson SH, Eurich DT, Majumdar SR, et al. A meta-analysis of the association between adherence to drug therapy and mortality. British Medical Journal 2006;333:15-20.
6. Heisler M, Choi H, Rosen AB, et al. Hospitalizations and deaths among adults with cardiovascular disease who underuse medications because of cost. Medical Care 2010;48(2):87-94.
7. Osterberg L, Blaschke T. Adherence to medication. The New England Journal of Medicine 2005;353(5):487-97.
8. Schoen C, Collins SR, Kriss JL, Doty MM. How many are underinsured? Trends among U.S. adults, 2003 and 2007. Health Affairs 2008;27(4):w298-w309.
9. Rovere M. Prescription drug spending in the United States and Canada. Fraser Forum 2010;July/August:26-8.
10. Ontario Ministry of Health and Long-Term Care. Ontario Public Drug Programs. (March 31, 2010) http://www.health.gov.on.ca/english/providers/p rogram/drugs/funded_drug/funded_drug.html (September 10, 2010).
11. Kapur V, Basu K. Drug coverage in Canada: who is at risk? Health Policy 2005;71:181-93.
12. Morrison A, MacKinnon NJ, Hartnell NR, McCaffrey KJ. Impact of drug plan management policies in Canada: A systematic review. Canadian Pharmacy Journal 2008;141:332-8.
13. Demers V, Melo M, Jackevicius C, et al. Comparison of provincial prescription drug plans and the impact on patients’ annual drug expenditures. Canadian Medical Association Journal 2008;178(4): 405-9.
14. Law MR, Cheng L, Dhalla IA, Heard D, Morgan SG. The effect of cost on adherence to prescription medications in Canada. CMAJ 2012;84(3):297-302.
15. Briesacher BA, Gurwitz JH, Soumerai SB. Patients at-risk for cost-related medication nonadherence: A review of the literature. Society of General Internal Medicine 2007;22:864-71.
16. Keller DL, Wright J, Pace HA. Impact of health literacy on health outcomes in ambulatory care patients: A systematic review. The Annals of Pharmacotherapy 2008;42:1272-81.
17. Lipscombe LL, Austin PC, Manuel DG, Shah BR, Hux JE, Booth GL. Income-related differences in mortality among people with diabetes mellitus. Canadian Medical Association Journal 2010; 182(1):E1-17.
18. Modi AC, Rausch JR, Glauser TA. Patterns of nonadherence to antiepileptic drug therapy in children with newly diagnosed epilepsy. Journal of the American Medical Association 2011;305(16): 1669-76.
19. Lexchin J, Grootendorst P. Effects of Prescription drug user fees on drug and health services use and on health status in vulnerable populations: A systematic review of the evidence. International Journal of Health Services 2004;34(1):101-22.
20. Canadian Institute for Health Information. National Health Expenditure Trends, 1975-2009. Ottawa, Ont.: CIHI, 2009.
21. Pharmaceutical Policy Research Collaboration. (2011) http://www.pharmaceuticalpolicy.ca/ (November 10 2011).
22. The NHS Information Centre for Health and Social Care. Health Survey of England 2007 Volume 2 Methodology and Documentation. London: NHS, 2007.
23. Powers BJ, Trinh JV, Bosworth HB. Can this patient read and understand written health information? Journal of the American Medical Association 2010;304(1):76-84.
24. Moisan J, Gaudet M, Gregoire JP, Bouchard R. Non-compliance with drug treatment and reading difficulties with regard to prescription labelling among seniors. Gerontology 2002;48:44-51.
25. Brooke P, Bullock R. Validation of a 6 item cognitive impairment test with a view to primary care usage. International Journal of Geriatric Psychiatry 1999;14:936-40.
26. Bebbington PE. The content and context of compliance. International Clinical Psychopharmacology 1995;9(S5):41-50.
27. Gusdal AK, Obua C, Andualem T, et al. Voices on adherence to ART in Ethiopia and Uganda: A matter of choice or simply not an option? AIDS Care 2009;21(11):1381-7.
28. Gebremariam MK, Bjune GA, Frich JC. Barriers and facilitators of adherence to TB treatment in patients on concomitant TB and HIV treatment: a qualitative study. BMC Public Health
2010;10:651.
29. Schafheutle E, Hassell K, Noyce PR. Coping with prescription charges in the UK. International Journal of Pharmacy Practice 2004;12:239-46.
30. Allan GM, Lexchin J, Wiebe N. Physician awareness of drug cost: A systematic review. PLoS Med 2007;4(9):e283.
31. Patel MR, Coffman JM, Tseng CW, Clark NM, Cabana MD. Physician communication regarding cost when prescribing asthma medication to children. Clinical Pediatrics 2009;48(5):493-8.
32. Brask-Lindemann D, Cadarette SM, Eskildsen P, Abrahamsen B. Osteoporosis pharmacotherapy following bone densitometry: Importance of patient beliefs and understanding of DXA results. 2011;22(5):1493-501.
33. Gellad WF, Huskamp HA, Li A, Zhang Y, Safran DG, Donohue JM. Use of prescription drug samples and patient assistance programs, and the role of doctor-patient communication. Journal of General Internal Medicine.2011;26(12):1458-64.

Most read articles by the same author(s)