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Annals of Emergency Medicine

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The Relationship Between Emergency Department Use and Cost-Related Medication Nonadherence Among Medicare Beneficiaries - 24/10/13

Doi : 10.1016/j.annemergmed.2013.04.013 
Janice Blanchard, MD, PhD a, ⁎ , Jeanne M. Madden, PhD b, Dennis Ross-Degnan, ScD b, Carol Roan Gresenz, PhD c, Stephen B. Soumerai, ScD b
a Department of Emergency Medicine, George Washington University, Washington, DC 
b Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 
c Department of Health Systems Administration, Georgetown University, Washington, DC 

Address for correspondence: Janice Blanchard, MD, PhD

Supervising editor: Donald M. Yealy, MD

Résumé

Study objective

The objective of this study was to evaluate the relationship between self-reported cost-related nonadherence to prescription medications and emergency department (ED) utilization among Medicare beneficiaries. We hypothesized that persons who report cost-related medication nonadherence would have subsequent higher ED use.

Methods

We conducted a retrospective cohort study of continuously enrolled Medicare beneficiaries in 2006 and 2007. We used multivariate logistic regression to evaluate the relationship between ED use and cost-related medication nonadherence. Our principal dependent variable was any ED visit within a 364-day period after an interview assessing cost-related medication nonadherence. Our principal independent variables both denoted cost-related medication nonadherence: mild cost-related medication nonadherence, defined as a reduction in dose or a delay in filling medications because of cost; and severe cost-related medication nonadherence, defined as not filling a medication at all because of cost.

Results

Our sample consisted of 7,177 Medicare Current Beneficiary Survey respondents. Approximately 7.5% of respondents reported mild cost-related medication nonadherence only (n=541) and another 8.2% reported severe cost-related medication nonadherence (n=581). Disabled Medicare beneficiaries with severe cost-related medication nonadherence were more likely to have at least 1 ED visit (1.53; 95% confidence interval 1.03 to 2.26) compared with both disabled Medicare beneficiaries without cost-related medication nonadherence and elderly Medicare beneficiaries in all cost-related medication nonadherence categories.

Conclusion

Our results show an association between severe cost-related medication nonadherence and ED use. Disabled beneficiaries younger than 65 years who report severe cost-related medication nonadherence were more likely to have at least 1 ED visit, even when adjusting for other factors that affect utilization.

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 Please see page 476 for the Editor's Capsule Summary of this article.
 Author contributions: JB, JMM, DR-D, and SBS conceived the study and obtained research funding. JB analyzed the data. JMM, DR-D, CRG, and SBS provided statistical advice on study design and analysis. JB drafted the article, and all authors contributed substantially to its revision. JB takes responsibility for the paper as a whole.
 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This work was supported by a Diversity Supplement to Dr. Blanchard to grants from the National Institutes of Aging (principal investigator, Dr. Soumerai; 1R01AG022362, 1R01AG028745, and 2R02AG028745). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
 Publication dates: Available online May 28, 2013.


© 2013  American College of Emergency Physicians. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 62 - N° 5

P. 475-485 - novembre 2013 Retour au numéro
Article précédent Article précédent
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