Abstract
Background and Aims: Medication nonadherence has been linked to poor cardiovascular health outcomes and increased healthcare utilization and costs. While studies examine medication pill counts, less is known about intentional adjustments in medication use due to economic factors. The purpose of this study is to examine factors affecting economically-driven medication nonadherence and the role of cardiovascular risk factors and disease in explaining emergency room (ER) use.
Methods: In 2006, survey instruments were mailed to a random sample of households in the seven county Brazos Valley region of Texas (n=1,935). Data were analyzed from a sample of 578 adults age 50 years and older. Study variables include: age (50–64 compared to 65 years and older), sex, education, race/ethnicity, residence rurality, body mass index, presence of cardiovascular risk factors, perceived access to care, medication adherence scores based on economic factors (6 items, a=0.77), and having visited the ER within the previous 12 months. Two independent logistic regression analyses were performed to identify variables associated with medication nonadherence and the frequency of ER visits.
Results: Over half of respondents (54.8%; 317 of 578) self-reported having cardiovascular disease (CVD) risk factors and 14.5% (84 of 578) reported having a cardiovascular incident. Medication nonadherence was reported by 25.3% (146 of 578) of respondents and 20.1% (116 of 578) reported having visited the ER in the previous 12 months. Medication nonadherence was associated with being younger (OR=0.431, P<0.001), having cardiovascular disease risk factors (OR=1.756, P<0.001), and perceiving less access to healthcare (OR=0.715, P<0.001). Visiting an ER in the previous 12 months was associated with having risk factors for cardiovascular disease (OR=1.441, P<0.05).
Conclusion: Medication nonadherence associated with economic constraints remains a problem for a small but significant group of community residing adults, which emphasizes a need for greater surveillance by the healthcare system. Even before the full implementation of Medicare Part D, persons age 65 years and older tended to adhere to medication regimens. The significance of CVD in this Medicare-eligible group as a predictor of ER visits suggests that additional self-management support and training are needed to recognize and address signs of disease exacerbation.
- Received May 27, 2010.
- Accepted May 27, 2010.
