Financial Strain and Medication Adherence among Diabetes Patients in an Integrated Health Care Delivery System: The Diabetes Study of Northern California (DISTANCE)

Health Serv Res. 2016 Apr;51(2):610-24. doi: 10.1111/1475-6773.12346. Epub 2015 Aug 9.

Abstract

Objective: To examine self-reported financial strain in relation to pharmacy utilization adherence data.

Data sources/study setting: Survey, administrative, and electronic medical data from Kaiser Permanente Northern California.

Study design: Retrospective cohort design (2006, n = 7,773).

Data collection/extraction methods: We compared survey self-reports of general and medication-specific financial strain to three adherence outcomes from pharmacy records, specifying adjusted generalized linear regression models.

Principal findings: Eight percent and 9 percent reported general and medication-specific financial strain. In adjusted models, general strain was significantly associated with primary nonadherence (RR = 1.37; 95 percent CI: 1.04-1.81) and refilling late (RR = 1.34; 95 percent CI: 1.07-1.66); and medication-specific strain was associated with primary nonadherence (RR = 1.42, 95 percent CI: 1.09-1.84).

Conclusions: Simple, minimally intrusive questions could be used to identify patients at risk of poor adherence due to financial barriers.

Keywords: Adherence; cost of care; diabetes; managed care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Antihypertensive Agents / administration & dosage
  • Antihypertensive Agents / economics
  • Assessment of Medication Adherence*
  • California
  • Delivery of Health Care, Integrated / statistics & numerical data
  • Diabetes Mellitus / drug therapy*
  • Drug Utilization / economics
  • Female
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Hypoglycemic Agents / economics*
  • Hypoglycemic Agents / therapeutic use
  • Hypolipidemic Agents / administration & dosage
  • Hypolipidemic Agents / economics
  • Male
  • Middle Aged
  • Retrospective Studies
  • Self Report*
  • Socioeconomic Factors

Substances

  • Antihypertensive Agents
  • Hypoglycemic Agents
  • Hypolipidemic Agents