Racial disparities in the quality of medication use in older adults: baseline findings from a longitudinal study

Abstract

Background: Medication-related problems are prevalent in older adults and adversely affect the quality of care. It has been suggested that racial differences exist in medication use. Most efforts to evaluate the quality of medication use target specific drugs or disease states, or a set of pre-defined quality indicators, rather than the patient.

Objective: We conducted a prospective cohort study to determine the prevalence and types of medication-related problems in older adults, examining the impact of race on quality medication use.

Methods: In-home interviews and medical record reviews of 200 (100 white, 100 black) older adults were conducted three times over 1 year. The quality of medication use was measured using a clinical pharmacist's assessment of quality and the Assessing Care of Vulnerable Elders quality indicators. We used logistic and negative binomial regression models to analyze the two primary endpoints of prevalence and number of medication-related problems.

Results: Mean age was 78.3 (whites) and 75.5 (blacks), with the majority being female. Although whites used more medications than blacks (11.6 versus 9.7; p < 0.01), blacks had more medication-related problems per person than whites (6.2 versus 4.9; p < 0.01). All patients had at least one medication-related problem; undertreatment, suboptimal drug, suboptimal dosing, and nonadherence were most prevalent. Blacks had significantly higher rates of nonadherence than whites (68% versus 42%; p < 0.01).

Conclusion: Medication-related problems are prevalent in community-residing older adults. Blacks had more medication-related problems than whites, including higher rates of nonadherence. These findings require further study to better understand racial disparities in quality medication use.

Figure 1

Prevalence of medication-related problems in community-residing older adults (n = 199), with prevalence defined as the number of older adults with any of the drug therapy problems/number of older adults in the sample (unadjusted). Odds ratios (OR) and 95% confidence intervals for race are included for the covariate adjusted models with White race being the reference category. ^*p < 0.05, ^†p < 0.01, ⁺too few events to calculate OR, White race (n=99, white bar), Black race (n=100, shaded bar).