Cost-related medication underuse: Prevalence among hospitalized managed care patients†
Article first published online: 3 OCT 2011
Copyright © 2011 Society of Hospital Medicine
Journal of Hospital Medicine
Volume 7, Issue 2, pages 104–109, February 2012
How to Cite
Choudhry, N. K., Saya, U. Y., Shrank, W. H., Greenberg, J. O., Melia, C., Bilodeau, A., Kadehjian, E. K., Dolan, M. L., Dudley, J. C. and Kachalia, A. (2012), Cost-related medication underuse: Prevalence among hospitalized managed care patients. J. Hosp. Med., 7: 104–109. doi: 10.1002/jhm.948
Disclosure: Drs Choudhry and Shrank received research support to study medication adherence from Aetna, Inc; CVS Caremark; the Robert Wood Johnson Foundation; and the Commonwealth Fund. Funding source: None.
- Issue published online: 6 FEB 2012
- Article first published online: 3 OCT 2011
- Manuscript Accepted: 2 MAY 2011
- Manuscript Revised: 27 APR 2011
- Manuscript Received: 28 OCT 2010
The affordability of prescription medications continues to be a major public health issue in the United States. Estimates of cost-related medication underuse come largely from surveys of ambulatory patients. Hospitalized patients may be vulnerable to cost-related underuse and its consequences, but have been subject to little investigation.
To determine impact of medication costs in a cohort of hospitalized managed care beneficiaries.
We surveyed consecutive patients admitted to medical services at an academic medical center. Questions about cost-related underuse were based on validated measures; predictors were assessed with multivariable models. Participants were asked about strategies to improve medication affordability, and were contacted after discharge to determine if they had filled newly prescribed medications.
One-hundred thirty (41%) of 316 potentially eligible patients participated; 93 (75%) of these completed postdischarge surveys. Thirty patients (23%) reported cost-related underuse in the year prior to admission. In adjusted analyses, patients of black race were 3.39 times (95% confidence interval [CI], 1.05 to 11.02) more likely to report cost-related underuse than non-Hispanic white patients. Virtually all respondents (n = 123; 95%) endorsed at least 1 strategy to make medications more affordable. Few (16%) patients, prescribed medications at discharge, knew how much they would pay at the pharmacy. Almost none had spoken to their inpatient (4%) or outpatient (2%) providers about the cost of newly prescribed drugs.
Cost-related underuse is common among hospitalized patients. Individuals of black race appear to be particularly at risk. Strategies should be developed to address this issue around the time of hospital discharge. Journal of Hospital Medicine 2012. © 2011 Society of Hospital Medicine