Abstract
Background: Many patients face a financial burden due to their medications, which may lead to poor health outcomes. The behaviors of non-adherence due to financial difficulties, known as cost-related medication non-adherence (CRN), include taking smaller doses of drugs, skipping doses to make prescriptions last longer, or delaying prescriptions. To date, the prevalence of CRN remains unknown, and there are few studies about the association of CRN on self-reported healthcare utilization (Emergency room (ER) visits and outpatient visits) and self-reported health outcomes (health status and disability status) among older adults taking antidepressants. Objectives: The objectives were to 1) examine the CRN prevalence, and 2) determine the association of CRN on self-reported healthcare utilization and self-reported health outcomes. Methods: This study was a cross-sectional study of a sample of older adults from the Medicare Current Beneficiary Survey (MCBS) who reported having used antidepressants in 2017. Four logistic regressions were implemented to evaluate the association of CRN, and self-reported healthcare utilization and self-reported health outcomes. Results: The study identified 602 participants who were Medicare beneficiaries on antidepressants. The prevalence of CRN among antidepressant users was (16.61%). After controlling for covariates, CRN was associated with poorer self-reported outcomes but not statistically significant: general health status [odds ratio (OR): 0.67; 95% confidence interval (CI): 0.39–1.16] and disability status (OR: 1.34; 95% CI: 0.83–2.14). In addition, CRN was associated with increased outpatient visits (OR: 1.89; 95% CI: 1.19–3.02), but not associated with ER visits (OR: 1.10; 95% CI: 0.69–1.76). Conclusion: For Medicare beneficiaries on antidepressants, CRN prevalence was high and contributed to more outpatient visits. The healthcare provider needs to define the reasoning for CRN and provide solutions to reduce the financial burden on the affected patient. Also, health care providers need to consider the factors that may enhance patient health status and healthcare efficiency.
Highlights
Many patients face a financial burden due to their medications, which may lead to poor health outcomes
Participants were excluded from the study if they were eligible for Medicare due to End-Stage Renal Disease (ESRD) or if they were enrolled in Health Maintenance Organization (HMO) plans
45.18% of the participants were age between 75 and 84 years old; 73.42% were female; 89.04% were White; 6.48% were African American; 2.99% were Hispanic; 41.69% were single; 40.70% of participants lived in the South; 74.92% were in metropolitan residence
Summary
Many patients face a financial burden due to their medications, which may lead to poor health outcomes. The behaviors of non-adherence due to financial difficulties, known as cost-related medication non-adherence (CRN), include taking smaller doses of drugs, skipping doses to make prescriptions last longer, or delaying prescriptions. The chemical imbalances in the brain contribute to changes in the patient’s behavior and mood (Harvard Health, 2019). Examples of these neurotransmitters are serotonin, dopamine and noradrenaline, and norepinephrine (Khushboo and Sharma, 2017). There are many antidepressant drug classes available to help with the chemical imbalance in the brain. 20% of older adults use antidepressants in a month, according to the National Center for Health Statistics (NCHS) (Products Data Briefs Number, 2020)
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