Assessing the Importance of Factors Associated with Cost-Related Nonadherence to Medication for Older US Medicare Beneficiaries

Dian Gu, Chan Shen

Research output: Contribution to journalArticle

Abstract

Background: Prescription drug costs have been rising rapidly in the USA, contributing to the persistent problem of cost-related medication nonadherence (CRN) among older Medicare beneficiaries. Given the importance of CRN and the negative outcomes associated with it, it is important to examine the factors that affect CRN. This study aims to estimate the factors influencing CRN among older Medicare beneficiaries and to rank their relative contribution in explaining CRN. Methods: We used a 2015 Medicare Current Beneficiary Survey linked to Medicare claims data to identify older Medicare beneficiaries aged 65 years and over. Multivariate logistic regression was performed to identify factors associated with CRN. Factors included in the regression analyses were based on a conceptual framework adapted from Piette et al., including main effects (financial factors and regimen complexity) and contextual factors (sociodemographic, lifestyle and health factors). Dominance analysis was conducted to determine their relative importance in predicting CRN. Results: Our study sample included 4427 older Medicare beneficiaries, 13.43% of whom reported CRN. For main effects, drug coverage and regimen complexity were significantly associated with CRN. Compared to beneficiaries with public coverage, those with private drug coverage were less likely to report CRN while those without drug coverage were more likely to report CRN. Having more than two monthly prescriptions was also associated with higher CRN. Significant contextual factors included age, activities of daily living limitations, perceived health status, cancer, rheumatoid arthritis, non-rheumatoid arthritis, depression, and lung disease. Dominance analysis showed drug coverage was the most influential factor in explaining CRN, after which age, ADL limitations, and depression ranked in sequence. Conclusions: These findings can help policy makers understand the relative importance of factors affecting CRN and identify the most important areas for intervention to improve CRN.

Original languageEnglish (US)
Pages (from-to)1111-1121
Number of pages11
JournalDrugs and Aging
Volume36
Issue number12
DOIs
StatePublished - Dec 1 2019

Fingerprint

Medication Adherence
Medicare
Costs and Cost Analysis
Activities of Daily Living
Pharmaceutical Preparations
Depression
Drug Costs
Prescription Drugs
Age Factors
Administrative Personnel
Lung Diseases
Health Status
Arthritis
Prescriptions

All Science Journal Classification (ASJC) codes

  • Geriatrics and Gerontology
  • Pharmacology (medical)

Cite this

@article{a28d4cdfc5124d41b07b7e11f5fd33df,
title = "Assessing the Importance of Factors Associated with Cost-Related Nonadherence to Medication for Older US Medicare Beneficiaries",
abstract = "Background: Prescription drug costs have been rising rapidly in the USA, contributing to the persistent problem of cost-related medication nonadherence (CRN) among older Medicare beneficiaries. Given the importance of CRN and the negative outcomes associated with it, it is important to examine the factors that affect CRN. This study aims to estimate the factors influencing CRN among older Medicare beneficiaries and to rank their relative contribution in explaining CRN. Methods: We used a 2015 Medicare Current Beneficiary Survey linked to Medicare claims data to identify older Medicare beneficiaries aged 65 years and over. Multivariate logistic regression was performed to identify factors associated with CRN. Factors included in the regression analyses were based on a conceptual framework adapted from Piette et al., including main effects (financial factors and regimen complexity) and contextual factors (sociodemographic, lifestyle and health factors). Dominance analysis was conducted to determine their relative importance in predicting CRN. Results: Our study sample included 4427 older Medicare beneficiaries, 13.43{\%} of whom reported CRN. For main effects, drug coverage and regimen complexity were significantly associated with CRN. Compared to beneficiaries with public coverage, those with private drug coverage were less likely to report CRN while those without drug coverage were more likely to report CRN. Having more than two monthly prescriptions was also associated with higher CRN. Significant contextual factors included age, activities of daily living limitations, perceived health status, cancer, rheumatoid arthritis, non-rheumatoid arthritis, depression, and lung disease. Dominance analysis showed drug coverage was the most influential factor in explaining CRN, after which age, ADL limitations, and depression ranked in sequence. Conclusions: These findings can help policy makers understand the relative importance of factors affecting CRN and identify the most important areas for intervention to improve CRN.",
author = "Dian Gu and Chan Shen",
year = "2019",
month = "12",
day = "1",
doi = "10.1007/s40266-019-00715-3",
language = "English (US)",
volume = "36",
pages = "1111--1121",
journal = "Drugs and Aging",
issn = "1170-229X",
publisher = "Adis International Ltd",
number = "12",

}

Assessing the Importance of Factors Associated with Cost-Related Nonadherence to Medication for Older US Medicare Beneficiaries. / Gu, Dian; Shen, Chan.

In: Drugs and Aging, Vol. 36, No. 12, 01.12.2019, p. 1111-1121.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Assessing the Importance of Factors Associated with Cost-Related Nonadherence to Medication for Older US Medicare Beneficiaries

AU - Gu, Dian

AU - Shen, Chan

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Background: Prescription drug costs have been rising rapidly in the USA, contributing to the persistent problem of cost-related medication nonadherence (CRN) among older Medicare beneficiaries. Given the importance of CRN and the negative outcomes associated with it, it is important to examine the factors that affect CRN. This study aims to estimate the factors influencing CRN among older Medicare beneficiaries and to rank their relative contribution in explaining CRN. Methods: We used a 2015 Medicare Current Beneficiary Survey linked to Medicare claims data to identify older Medicare beneficiaries aged 65 years and over. Multivariate logistic regression was performed to identify factors associated with CRN. Factors included in the regression analyses were based on a conceptual framework adapted from Piette et al., including main effects (financial factors and regimen complexity) and contextual factors (sociodemographic, lifestyle and health factors). Dominance analysis was conducted to determine their relative importance in predicting CRN. Results: Our study sample included 4427 older Medicare beneficiaries, 13.43% of whom reported CRN. For main effects, drug coverage and regimen complexity were significantly associated with CRN. Compared to beneficiaries with public coverage, those with private drug coverage were less likely to report CRN while those without drug coverage were more likely to report CRN. Having more than two monthly prescriptions was also associated with higher CRN. Significant contextual factors included age, activities of daily living limitations, perceived health status, cancer, rheumatoid arthritis, non-rheumatoid arthritis, depression, and lung disease. Dominance analysis showed drug coverage was the most influential factor in explaining CRN, after which age, ADL limitations, and depression ranked in sequence. Conclusions: These findings can help policy makers understand the relative importance of factors affecting CRN and identify the most important areas for intervention to improve CRN.

AB - Background: Prescription drug costs have been rising rapidly in the USA, contributing to the persistent problem of cost-related medication nonadherence (CRN) among older Medicare beneficiaries. Given the importance of CRN and the negative outcomes associated with it, it is important to examine the factors that affect CRN. This study aims to estimate the factors influencing CRN among older Medicare beneficiaries and to rank their relative contribution in explaining CRN. Methods: We used a 2015 Medicare Current Beneficiary Survey linked to Medicare claims data to identify older Medicare beneficiaries aged 65 years and over. Multivariate logistic regression was performed to identify factors associated with CRN. Factors included in the regression analyses were based on a conceptual framework adapted from Piette et al., including main effects (financial factors and regimen complexity) and contextual factors (sociodemographic, lifestyle and health factors). Dominance analysis was conducted to determine their relative importance in predicting CRN. Results: Our study sample included 4427 older Medicare beneficiaries, 13.43% of whom reported CRN. For main effects, drug coverage and regimen complexity were significantly associated with CRN. Compared to beneficiaries with public coverage, those with private drug coverage were less likely to report CRN while those without drug coverage were more likely to report CRN. Having more than two monthly prescriptions was also associated with higher CRN. Significant contextual factors included age, activities of daily living limitations, perceived health status, cancer, rheumatoid arthritis, non-rheumatoid arthritis, depression, and lung disease. Dominance analysis showed drug coverage was the most influential factor in explaining CRN, after which age, ADL limitations, and depression ranked in sequence. Conclusions: These findings can help policy makers understand the relative importance of factors affecting CRN and identify the most important areas for intervention to improve CRN.

UR - http://www.scopus.com/inward/record.url?scp=85074798688&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074798688&partnerID=8YFLogxK

U2 - 10.1007/s40266-019-00715-3

DO - 10.1007/s40266-019-00715-3

M3 - Article

C2 - 31686403

AN - SCOPUS:85074798688

VL - 36

SP - 1111

EP - 1121

JO - Drugs and Aging

JF - Drugs and Aging

SN - 1170-229X

IS - 12

ER -