title: Financial Strain and Medication Adherence among Diabetes Patients in an Integrated Health Care Delivery System: The Diabetes Study of Northern California (DISTANCE).
abstract: OBJECTIVE
  To examine self-reported financial strain in relation to pharmacy utilization adherence data.
  
  
  METHODS
  Survey, administrative, and electronic medical data from Kaiser Permanente Northern California.
  
  
  METHODS
  Retrospective cohort design (2006, n = 7,773).
  
  
  METHODS
  We compared survey self-reports of general and medication-specific financial strain to three adherence outcomes from pharmacy records, specifying adjusted generalized linear regression models.
  
  
  RESULTS
  Eight percent and 9 percent reported general and medication-specific financial strain. In adjusted models, general strain was significantly associated with primary nonadherence (RR = 1.37; 95 percent CI: 1.04-1.81) and refilling late (RR = 1.34; 95 percent CI: 1.07-1.66); and medication-specific strain was associated with primary nonadherence (RR = 1.42, 95 percent CI: 1.09-1.84).
  
  
  CONCLUSIONS
  Simple, minimally intrusive questions could be used to identify patients at risk of poor adherence due to financial barriers.
authors.affiliation: University of California San Francisco, 1001 Potrero Ave, San Francisco, CA.|Kaiser Permanente Northern California Division of Research, Oakland, CA.
authors.forename: Courtney R
authors.initials: CR
authors.lastname: Lyles
authors.affiliation: Division of General Internal Medicine at SFGH, UCSF Center for Vulnerable Populations, San Francisco, CA.
authors.forename: Hilary K
authors.initials: HK
authors.lastname: Seligman
authors.affiliation: Kaiser Permanente Northern California Division of Research, Oakland, CA.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Parker
authors.affiliation: Kaiser Permanente Northern California Division of Research, Oakland, CA.
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.affiliation: UCSF Departments of Psychiatry and Pediatrics, San Francisco, CA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Adler
authors.affiliation: Division of General Internal Medicine at SFGH, UCSF Center for Vulnerable Populations, San Francisco, CA.|Kaiser Permanente Northern California Division of Research, Oakland, CA.
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.affiliation: Schools of Public Health and Medicine, VA Ann Arbor Center for Clinical Management Research, University of Michigan, Ann Arbor, MI.
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.affiliation: Kaiser Permanente Northern California Division of Research, Oakland, CA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
mesh_terms: D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000191:economics; D002140:California; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000188:drug therapy*; D004363:Drug Utilization / Q000191:economics; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D057566:Self Report; D012959:Socioeconomic Factors; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents
keywords: Adherence; cost of care; diabetes; managed care