A pilot study on cost-related medication nonadherence in Ontario.
BACKGROUND
Cost-related nonadherence (CRN) describes patients cutting back on their prescribed medication due to an inability to pay. CRN is influenced by drug insurance coverage plans, which vary widely among different healthcare systems. Little is known about CRN in Canada and Ontario.


OBJECTIVE
To develop and pilot a questionnaire about CRN.


METHODS
An interviewer-administered questionnaire assessing demographics, socioeconomic status, health status and health literacy, medication costs and CRN was developed for this pilot study. Participants were recruited from a general internal medicine rapid assessment outpatient clinic of a large urban teaching hospital.


RESULTS
Sixty patients were recruited (mean age 60.3 years; 48.3% female; mean of 5.3 prescription medications per patient). Nine patients (15%) reported some form of CRN. Unfilled prescriptions, delayed prescriptions, less frequent and smaller doses were the most common forms of CRN. Seven patients (11.7%) had no drug insurance. Patients without drug insurance were more likely to experience CRN than patients with private insurance (OR 20.70, 95% CI 1.46-292.75); government coverage also increased the likelihood of CRN compared to private coverage (OR 4.51, 95% CI 0.376-54.11). Patients spending over $100 a month out-of-pocket were more likely to experience CRN than patients spending less than $20 (OR 42.52, 95% CI 2.02-894.03). Thirty-three patients (55%) said that their physicians had not asked them about how they deal with the cost of prescriptions.


CONCLUSIONS
Based on our pilot survey, a significant minority of specialty clinic outpatients experience CRN and prescribers frequently forget to inquire whether patients can afford their medications.
Bachelor of Health Sciences Program, McMaster University, Canada.
Bo
B
Zheng
Alice
A
Poulose
Martha
M
Fulford
Anne
A
Holbrook
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D016527:Drug Costs; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data; D006304:Health Status; D006784:Hospitals, Teaching; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010865:Pilot Projects; D055553:Prescription Drugs / Q000008:administration & dosage / Q000191:economics; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014505:Urban Population; D055815:Young Adult; D016903:Drug Monitoring
D055553:Prescription Drugs