Cost-Related Medication Nonadherence (CRN) on Healthcare Utilization and Patient-Reported Outcomes: Considerations in Managing Medicare Beneficiaries on Antidepressants

Abdulrahman A Alnijadi; Jing Yuan; Jun Wu; Minghui Li; Z Kevin Lu

doi:10.3389/fphar.2021.764697

Cost-Related Medication Nonadherence (CRN) on Healthcare Utilization and Patient-Reported Outcomes: Considerations in Managing Medicare Beneficiaries on Antidepressants

Front Pharmacol. 2021 Dec 7:12:764697. doi: 10.3389/fphar.2021.764697. eCollection 2021.

Authors

Abdulrahman A Alnijadi^{1

2}, Jing Yuan³, Jun Wu⁴, Minghui Li⁵, Z Kevin Lu¹

Affiliations

¹ Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC, United States.
² Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.
³ Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Fudan University, Shanghai, China.
⁴ Department of Pharmaceutical and Administrative Sciences, Presbyterian College, Clinton, SC, United States.
⁵ Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, United States.

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.

Keywords: antidepressants; cost-related medication nonadherence; healthcare utilization; medicare beneficiaries; older adults; patient reported outcomes.