Abstract
Background/Aims Initial adherence to prescribed medications immediately following hospital discharge represents a crucial treatment phase, significantly affecting the course of care and subsequent readmission risk. Numerous psychosocial factors influence adherence, particularly in vulnerable populations such as patients with lower health literacy and few healthcare or economic resources. Race/ethnicity is frequently associated with poor adherence and may detrimentally interact with issues surrounding important self-care behaviors. Within a cohort of medical aid program recipients, our pilot study objectives were to examine potential ethnic disparities in several factors pertaining to early adherence, supporting efforts to design tailored interventions to improve hospital transition care and outcomes.
Methods Within 15 days of discharge from one Scott & White Healthcare facility, adult participants (n = 90) completed surveys soliciting demographics and several instruments including medication adherence (Morisky 4-item), health literacy (REALM-SF), and depression (CES-D), along with perceptions of treatment engagement or self-activation, social support, personal competence, and quality of hospital transition care. Among these Medicaid recipients, preliminary bivariate analyses examined differences by race/ethnic group, supporting ongoing regression and structural equation models.
Results The sample was 62% female, with a mean age of 50.4 (sd = 13.5); 56% were White, 26% African-American, while one-fifth reported Hispanic ethnicity. Most patients reported medium (38%) or high adherence (49%), white patients having a greater prevalence of the latter category despite endorsing higher depression levels. The only statistical difference was lower scores in minority patients for treatment engagement (P = .02), yet these individuals also reported diminished perceived competency and treatment activation, while more African-Americans had lower health literacy levels.
Conclusions Although this small sample yielded few statistically significant results in adherence or potential contributing factors, lower ethnic minority scores on several measures is troubling. As only half of respondents demonstrated health literacy equivalent to high school or above, tailored educational materials are vital for this cohort. The complex role of multiple patient and health delivery characteristics that bolster self-care behavior offers a promising pathway for better hospital transition interventions. Besides other available information including administrative utilization data and follow-up calls, further analyses will explore interaction effects illuminating unique areas for culturally sensitive, innovative implementations.
