title: Medication Nonadherence Before Hospitalization for Acute Cardiac Events.
abstract: Medication nonadherence increases the risk of hospitalization and poor outcomes, particularly among patients with cardiovascular disease. The purpose of this study was to examine characteristics associated with medication nonadherence among adults hospitalized for cardiovascular disease. Patients in the Vanderbilt Inpatient Cohort Study who were admitted for acute coronary syndrome or heart failure completed validated assessments of self-reported medication adherence (the Adherence to Refills and Medications Scale), demographic characteristics, health literacy, numeracy, social support, depressive symptoms, and health competence. We modeled the independent predictors of nonadherence before hospitalization, standardizing estimated effects by each predictor's interquartile range. Among 1,967 patients studied, 70.7% indicated at least some degree of medication nonadherence leading up to their hospitalization. Adherence was significantly lower among patients with lower health literacy (0.18-point change in adherence score per interquartile range change in health literacy), lower numeracy (0.28), lower health competence (0.30), and more depressive symptoms (0.52) and those of younger age, of non-White race, of male gender, or with less social support. Medication nonadherence in the period before hospitalization is more prevalent among patients with lower health literacy, numeracy, or other intervenable psychosocial factors. Addressing these factors in a coordinated care model may reduce hospitalization rates.
authors.affiliation: a Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA.|b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA.|c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.affiliation: b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA.|c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Goggins
authors.affiliation: d Department of Biostatistics , Vanderbilt University Medical Center , Nashville , Tennessee , USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Nwosu
authors.affiliation: d Department of Biostatistics , Vanderbilt University Medical Center , Nashville , Tennessee , USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Schildcrout
authors.affiliation: a Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA.|b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA.|c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA.|e Department of Veterans Affairs , Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center , Nashville , Tennessee , USA.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Mixon
authors.affiliation: f Department of Emergency Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA.
authors.forename: Candace
authors.initials: C
authors.lastname: McNaughton
authors.affiliation: c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA.|f Department of Emergency Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA.|g Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , Tennessee , USA.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: McDougald Scott
authors.affiliation: h School of Nursing , Vanderbilt University Medical Center , Nashville , Tennessee , USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Wallston
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology / Q000628:therapy*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003863:Depression / Q000523:psychology; D004522:Educational Status; D057220:Health Literacy / Q000706:statistics & numerical data; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D012944:Social Support; D013714:Tennessee; D016903:Drug Monitoring