title: Coping strategies used by patients infected with hepatitis C virus who are facing medication costs.
abstract: BACKGROUND
  The prevalence of infection with hepatitis C virus (HCV) is increasing worldwide. Antiviral therapy, prescription and nonprescription medications, and nondrug therapies to treat HCV infection and to manage associated adverse effects are costly.
  
  
  OBJECTIVE
  To determine whether individuals infected with HCV attending a hepatology clinic were negatively affected by the costs of prescription medications, and if so, to determine coping strategies they adopted.
  
  
  METHODS
  Patients infected with HCV attending Hepatology Services, a clinic within the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, were interviewed as part of an exploratory study (April 2 to July 8, 2008). The interview was based on a validated survey adapted for Nova Scotia. Information collected included demographic characteristics; types of prescription, nonprescription, and complementary medications used by patients; and strategies patients adopted to pay their medication costs.
  
  
  RESULTS
  Fifty patients (age 33-64 years) participated in the interviewer-administered survey, including 35 (70%) men and 19 people (38%) with household income less than $30 000. Frequently used medications were antidepressants (19 patients [38%]), antihypertensive agents (12 [24%]), anxiolytics (10 [20%]), and nonsteroidal anti-inflammatory drugs (10 [20%]). More than half (29 [58%]) were concerned about having sufficient money to pay for their medications. Coping strategies adopted in response to costs of prescription medications were either self-initiated or undertaken in consultation with physicians and/or other health care professionals. Sixteen (32%) of the respondents expressed the belief that physicians usually do not consider patients' concerns about affordability when prescribing medications. Seven (14%) indicated they would seek help from a pharmacist to buy low-cost substitutes for their medications.
  
  
  CONCLUSIONS
  This study highlighted a range of coping strategies adopted by patients infected with HCV in response to medication costs. It underscores that cost may limit access to essential medications within this patient population, even in a publicly funded health care system. Some of the coping strategies adopted might reduce patients' persistence and adherence with medication therapy, which could lead to adverse health outcomes. Hospital and community pharmacists need to be aware of the challenges faced by patients in terms of paying for medications and should consider possible proactive responses to address potentially detrimental coping strategies.
authors.affiliation: , MSc, is with the College of Pharmacy and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Chiranjeev
authors.initials: C
authors.lastname: Sanyal
authors.forename: Ethel Langille
authors.initials: EL
authors.lastname: Ingram
authors.forename: Ingrid S
authors.initials: IS
authors.lastname: Sketris
authors.forename: Kevork M
authors.initials: KM
authors.lastname: Peltekian
authors.forename: Susan
authors.initials: S
authors.lastname: Kirkland