16: Sex Differences in Platelet Activation in Patients With Acute Coronary Syndromes

Abstract

ingly, there is a high rate of noncompliance for prescription drugs based on affordability. Such noncompliance can negatively impact health care outcomes. There have been very few studies that evaluate the linkage between prescription drug affordability with utilization of the ED. This study evaluates how ED resource utilization is impacted by barriers to access to care, specifically prescription drug use. Methods: The first part of this study evaluated medication affordability among uninsured patients with chronic diseases. Using multivariate analysis to control for sociodemographic characteristics, the relationship between medication affordability and health care utilization measures (ED, days of hospitalization) and average expenditures was evaluated using data from the Community Tracking Survey (CTS). The potential impact of state programs that would cover prescription drug spending for the poor and uninsured chronically ill adult population (ages 18–64) on medication affordability and utilization was then simulated. Results: Using multivariate analysis to evaluate the subset of patients (ages 18–64) in the CTS with chronic illnesses (asthma, diabetes, COPD, hypertension, heart disease, asthma) n 11117, factors associated with not being able to afford medications included being Black, lacking insurance and having incomes less than 200% of poverty (P 0.001). For chronically ill adults, lack of medication affordability was associated with an average of 1.06 ED visits per year, versus 0.34 visits among those who stated that they could afford their medications; and an average of 0.23 days of hospitalization, versus 0.09 among those who could afford their medications (p 0.001.) Expanding insurance coverage for the uninsured up to 200% of poverty would potentially decrease the number of persons with chronic illnesses who could not afford their medications from 56.4% to 36%. Conclusions: Lack of medication affordability is associated with increased numbers of ED visits and days of hospitalization among the chronically ill. It therefore may be an additional stressor to the health care safety net. Options to increase access to care for vulnerable populations, such as expanding prescription drug coverage and local health care insurance expansions, such as that in Washington DC, have the potential to significantly increase access and decrease resource utilization.