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: To assess potential associations among physician counseling, pharmacist counseling, written medicine information (WMI) and patient awareness of non-steroidal anti-inflammatory drug (NSAID) risks. Three-hundred and eighty-two older, white and African American patients prescribed NSAIDs were surveyed regarding their NSAID risk awareness defined as an index score ranging from zero to four correctly identified risks (i.e., gastrointestinal bleeding, heart attack, hypertension, and kidney disease). Associations among NSAID risk awareness and patient-reported physician counseling, pharmacist counseling, and reading of WMI were evaluated in multivariable ordered logistic regression models and confirmed using path analysis. Physician counseling was positively associated with reading WMI (p<0.001) and NSAID risk awareness (p<0.001). Pharmacist counseling was not associated with reading WMI (p=0.622) and neither pharmacist counseling (p=0.366) nor reading WMI (p=0.916) was associated with NSAID risk awareness. Physicians play a prominent role in facilitating NSAID risk awareness whereas pharmacist counseling and WMI may have limited impact. The lack of significant associations among pharmacist counseling and reading WMI with NSAID risk awareness suggests a missed opportunity to improve patient understanding. There is a need for coordinated and effective strategies to communicate risk information among physicians and pharmacists and to better integrate WMI into this process.Patient Education and Counseling 12/2010; 83(3):391-7. DOI:10.1016/j.pec.2010.10.032
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ABSTRACT: To examine the prevalence of patient-pharmacy staff communication about medications for pain and arthritis and to assess disparities in communication by demographic, socioeconomic, and health indicators. Descriptive, nonexperimental, cross-sectional study. Alabama between 2005 and 2007. 687 Patients participating in the Alabama NSAID Patient Safety Study (age >or=50 years and currently taking a prescription nonsteroidal anti-inflammatory drug [NSAID]). Not applicable. Communication with pharmacy staff about prescription and over-the-counter (OTC) NSAIDs was examined before and after adjustment for demographic, socioeconomic, and health indicators. For the entire cohort (n = 687), mean (+/-SD) age was 68.3 +/- 10.0 years, 72.8% were women, 36.4% were black, and 31.2% discussed use of prescription pain/arthritis medications with pharmacy staff. Discussing use of prescription pain/arthritis medications with pharmacy staff differed by race/gender (P < 0.001): white men (40.3%), white women (34.6%), black men (30.2%), and black women (19.8%). Even after multivariable adjustment, black women had the lowest odds of discussing their medications with pharmacy staff (odds ratio 0.40 [95% CI 0.24-0.56]) compared with white men. For the 63.0% of participants with recently overlapping prescription and OTC NSAID use, communication with pharmacy staff about OTC NSAIDs use was only 13.7% and did not vary significantly by race/gender group. Given the complex risks and benefits of chronic NSAID use, pharmacists, pharmacy staff, and patients all are missing an important opportunity to avoid unsafe prescribing and decrease medication adverse events.Journal of the American Pharmacists Association 09/2009; 49(5):e110-7. DOI:10.1331/JAPhA.2009.09005
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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.