Assessment of cost-related medication nonadherence during routine hospital-based care: Association with racial disparities and hospital utilization

Abstract

Purpose: Cost-related medication nonadherence (CRNA) is a prevalent public health problem tied to social determinants of health. The purpose of this study was to describe a method to collect CRNA and the association this has with hospital utilization, as well as potential racial disparities in the prevalence of CRNA.

Methods: We conducted a pilot prospective observational study by embedding 2 validated survey questions aimed at capturing CRNA into the admission process in an academic 10-hospital system. We evaluated process adherence and the association between CRNA and patient demographics, outcomes, and overall hospital utilization.

Results: During the study period, 7,831 patients were admitted, of whom 2,878 were screened for CRNA. Of those screened, 144 (5.0%) reported experiencing CRNA in the last year and 45 (3.4%) reported experiencing CRNA in the last 3 months. Patients with CRNA were younger, more likely to be male and nonwhite, and had higher rates of chronic comorbidities. Patients who reported experiencing CRNA in the last 3 months had a longer initial length of stay, but only 5% had an ambulatory pharmacy follow-up visit. Overall process adherence was higher for white patients, largely due to hospital-level effects.

Conclusion: Embedding assessment for CRNA into routine care captures a medically complex and socially vulnerable population. Assessment of CRNA represents a critical first step in addressing an important social determinant of health and represents an opportunity to standardize care to reduce cost, as well as improve equity and patient outcomes.

Keywords: economic instability; medication affordability; medication nonadherence; social determinants of health.