Effect of racial differences on ability to afford prescription medications
ABSTRACT The association of race with not filling prescription medications because of cost for African-American and white patients 65 years or older was examined.
African-American and white patients age 65 years or older were recruited from the practices of 48 Alabama primary care physicians participating in the Alabama Nonsteroidal Antiinflammatory Drug Patient Safety Study. All eligible patients were asked questions related to their ability to pay for prescription medications, comorbidities, insurance status, and socioeconomic status. Baseline and follow-up telephone surveys were completed between August 2005 and April 2006. Mediation analysis was conducted to determine whether patients' perceived income inadequacy mediated the association between race and not filling medications using staged logistic regression models and adjusting for age, comorbidities, and traditional markers of socioeconomic position (income, education, and insurance status).
Of 399 participants, 32% were African-American, 74% were women, and 53% had an annual household income of <$15,000. Patients not filling prescription medications were more likely to be African-American (50% versus 25%) and to report inadequate income to meet basic needs (61% versus 17%) (p < 0.001 for both comparisons). After adjusting for all covariates except the mediator, the odds ratio (OR) for African Americans not filling a prescription medication was 2.3 when compared with white patients. Adding the mediator (perceived income inadequacy) to the model reduced the OR to 1.4.
African Americans reported markedly greater difficulty in affording prescription medications than did white patients, even after accounting for income, education, health insurance status, and comorbidities. The inability of African Americans to afford prescription medications may be better predicted by perceived income inadequacy than more traditional measures of socioeconomic status.
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ABSTRACT: This study examined the relationship between food insecurity and cost-related medication non-adherence in a population of low-income older adults in Georgia. This study used data from the Georgia Advanced Performance Outcomes Measures Project to evaluate new Older Americans Act Nutrition Program participants and waitlisted people (n = 1000, mean age 75.0 ± 9.1 years, 68.4% women, 25.8% black). Food insecurity was assessed using the modified 6-item USDA Household Food Security Survey Module. Practice of 5 CRN behaviors (e.g., delaying refills, skipping doses) was evaluated. Approximately 49.7% of participants were food insecure, while 44.4% had utilized ≥1 CRN strategy (CRN-P). Those who were food insecure and/or who reported CRN-P were more likely to be black, low-income, younger, and less educated. After controlling for confounders, food insecure participants were 2.9 (95% CI 2.2, 4.0) times more likely to report CRN-P. Improving food security is important for low-income older adults to promote adherence to recommended prescription regimens.
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ABSTRACT: Area probability sampling via U.S. postal addresses was used to select households from seven high poverty U.S. metropolitan areas. In person and telephone interviews with one adult household member were used to determine the odds of delaying or failing to fill a needed prescription for families with a child member with a limiting health condition. Logistic models indicate families with a child with a limiting health condition are 1.57 times more likely to delay or fail to fill a needed prescription, and families with more than one child with a limiting condition are 1.85 times more likely. Implications are set forth.Social Work in Health Care 02/2015; 54(2):101-117. DOI:10.1080/00981389.2014.975315 · 0.62 Impact Factor
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ABSTRACT: Issues related to prescribing dermatologic drugs in the elderly are less recognized than age-related skin findings. This is related in part to the lack of a standardized residency training curriculum in geriatric dermatology. As the number of elderly patients rises in the United States, drug-related iatrogenic complications will become increasingly important. This review discusses age-related changes in pharmacokinetics and pharmacodynamics of common dermatologic drugs. These changes include volume of distribution, renal function, liver toxicity from interactions of commonly prescribed drugs, and medications that can decompensate cognition in the older patient population. We outline seven prescribing principles related to older dermatology patients, including useful strategies to reduce polypharmacy and improve drug adherence, using an evidence-based approach whenever possible.Journal of the American Academy of Dermatology 04/2013; 68(4):521.e1-521.e10. DOI:10.1016/j.jaad.2012.10.063 · 5.00 Impact Factor