title: Awareness of pharmaceutical cost-assistance programs among inner-city seniors.
abstract: BACKGROUND
  Lack of awareness may be a significant barrier to participation by low- and middle-income seniors in pharmaceutical cost-assistance programs.
  
  
  OBJECTIVE
  The goal of this study was to determine whether older adults' awareness of 2 major state and federal pharmaceutical cost-assistance programs was associated with the seniors' ability to access and process information about assistance programs.
  
  
  METHODS
  Data were gathered from a cross-sectional study of independently living, English- or Spanish-speaking adults aged > or =60 years. Participants were interviewed in 30 community-based settings (19 apartment complexes and 11 senior centers) in New York, New York. The analysis focused on adults aged > or =65 years who lacked Medicaid coverage. Multivariable logistic regression was used to model program awareness as a function of information access (family/social support, attendance at senior or community centers and places of worship, viewing of live health insurance presentations, instrumental activities of daily living, site of medical care, computer use, and having a proxy decision maker for health insurance matters) and information-processing ability (education level, English proficiency, health literacy, and cognitive function). The main outcome measure was awareness of New York's state pharmaceutical assistance program (Elderly Pharmaceutical Insurance Coverage [EPIC]]) and the federal Medicare Part D low-income subsidy program (Extra Help).
  
  
  RESULTS
  A total of 269 patients were enrolled (mean [SD] age, 76.9 [7.5] years; 32.0% male; 39.9% white). Awareness of the programs differed widely: 77.3%) knew of EPIC! and 22.3% knew of Extra Help. In multivariable analysis, study participants were more likely to have heard of the EPIC program if they had attended a live presentation about health insurance issues (adjusted odds ratio [AOR], 3.40; 95% CI, 1.20-9.61) and less likely if they received care in a clinic (AOR, 0.45; 95% CI, 0.23-0.92). Awareness of Extra Help in the multivariable models was more likely among study participants who had viewed a live health insurance presentation (AOR, 3.35; 95% CI, 1.55-7.24) and less likely for those with inadequate health literacy (AOR, 0.15; 95% CI, 0.03-0.74).
  
  
  CONCLUSIONS
  Viewing of live health insurance presentations and adequate health literacy were associated with greater awareness of important pharmaceutical cost-assistance programs in this study in low-income, elderly individuals. The findings suggest that use of live presentations, in addition to health literacy materials and messages, may be important strategies in promoting knowledge of and enrollment in state and federal pharmaceutical cost-assistance programs for low-income seniors.
authors.affiliation: Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York, USA. alex.federman@mssm.edu
authors.forename: Alex D
authors.initials: AD
authors.lastname: Federman
authors.forename: Dana Gelb
authors.initials: DG
authors.lastname: Safran
authors.forename: Salomeh
authors.initials: S
authors.lastname: Keyhani
authors.forename: Helen
authors.initials: H
authors.lastname: Cole
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.forename: Albert L
authors.initials: AL
authors.lastname: Siu
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001296:Audiovisual Aids; D001364:Awareness; D032882:Comprehension; D017047:Cost Sharing; D003430:Cross-Sectional Studies; D016527:Drug Costs / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008389:Marketing of Health Services; D054524:Medicare Part D / Q000191:economics* / Q000706:statistics & numerical data; D009519:New York City; D010353:Patient Education as Topic; D013221:State Health Plans / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States; D019037:Urban Health Services / Q000191:economics* / Q000706:statistics & numerical data