Factors Influencing Cost-Related Nonadherence to Medication in Older Adults: A Conceptually Based Approach

Authors

  • Kara Zivin PhD,

    Corresponding author
    1. Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA;
    2. Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA;
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  • Scott Ratliff MS,

    1. Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA;
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  • Michele M. Heisler MD,

    1. Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA;
    2. Division of General Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA;
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  • Kenneth M. Langa MD, PhD,

    1. Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA;
    2. Division of General Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA;
    3. Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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  • John D. Piette PhD

    1. Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA;
    2. Division of General Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA;
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Kara Zivin, University of Michigan Medical School, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Road, Box 5765, Ann Arbor, MI 48109, USA. E-mail: kzivin@umich.edu

ABSTRACT

Objective:  Although multiple noncost factors likely influence a patient's propensity to forego treatment in the face of cost pressures, little is known about how patients' sociodemographic characteristics, physical and behavioral health comorbidities, and prescription regimens influence cost-related nonadherence (CRN) to medications. We sought to determine both financial and nonfinancial factors associated with CRN in a nationally representative sample of older adults.

Methods:  We used a conceptual model developed by Piette and colleagues that describes financial and nonfinancial factors that could increase someone's risk of CRN, including income, comorbidities, and medication regimen complexity. We used data from the 2004 wave of the Health and Retirement Study and the 2005 HRS Prescription Drug Study to examine the influence of factors within each of these domains on measures of CRN (including not filling, stopping, or skipping doses) in a nationally representative sample of Americans age 65+ in 2005.

Results:  Of the 3071 respondents who met study criteria, 20% reported some form of CRN in 2005. As in prior studies, indicators of financial stress such as higher out-of-pocket payments for medications and lower net worth were significantly associated with CRN in multivariable analyses. Controlling for these economic pressures, relatively younger respondents (ages 65–74) and depressive symptoms were consistent independent risk factors for CRN.

Conclusions:  Noncost factors influenced patients' propensity to forego treatment even in the context of cost concerns. Future research encompassing clinician and health system factors should identify additional determinants of CRN beyond patients' cost pressures.

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