title: Patterns of medication adherence and health care utilization among patients with chronic disease who were enrolled in a pharmacy assistance program.
abstract: BACKGROUND
  Poor medication adherence due to high drug costs is a barrier to optimal health outcomes among low-income uninsured patients with chronic conditions. Charitable pharmacy assistance programs provide medications to such patients, but little is known about the utilization patterns of program participants.
  
  
  METHODS
  We used a retrospective cohort design to investigate 6-month outcomes for participants in the University of North Carolina (UNC) Health Care Pharmacy Assistance Program (PAP) who received medications indicated for hypertension, diabetes, and/or hyperlipidemia from 2009 through 2011. Logistic regression was used to analyze predictors of medication adherence and to evaluate the association between adherence and use of emergency and inpatient care.
  
  
  RESULTS
  The 3 study cohorts included 866 patients receiving antihypertensive agents, 265 patients receiving oral glucose-lowering agents, and 455 patients receiving statins. When assessed 6 months after program enrollment, 52%, 45%, and 38% of patients in these 3 groups, respectively, were at least 80% adherent to treatment. Adherent patients in all cohorts had lower odds of requiring inpatient or emergency department care, but the decrease was only statistically significant among those taking antihypertensive agents (odds ratio for hospitalization = 0.58; 95% confidence interval, 0.39-0.87).
  
  
  CONCLUSIONS
  Selection bias and inability to capture utilization data from sources other than UNC Health Care may have biased results.
  
  
  CONCLUSIONS
  Approximately 50% of PAP participants were adherent to chronic disease medications. Adherence to such therapies among patients who are receiving financial assistance with medications may reduce their need for costly health care services. Future research should assess the long-term ability of pharmacy assistance programs to promote medication adherence and should examine alternative strategies for improving adherence and health outcomes among low-income uninsured patients.
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill; Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Roberts
authors.affiliation: Department of Pharmacy, University of North Carolina Hospitals and Clinics; Division of Pharmacy Practice and Experiential Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Ginny D
authors.initials: GD
authors.lastname: Crisp
authors.affiliation: Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, Connecticut, USA.
authors.forename: Denise A
authors.initials: DA
authors.lastname: Esserman
authors.affiliation: Division of Pharmaceutical Outcome and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Roth
authors.affiliation: Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Durham VAMC Center for Health Services Research, Durham, North Carolina, USA.
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. jffarley@unc.edu.
authors.forename: Joel F
authors.initials: JF
authors.lastname: Farley
mesh_terms: D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D007356:Insurance, Pharmaceutical Services; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009657:North Carolina; D012189:Retrospective Studies; D014495:Universities