title: Patient-reported financial barriers to adherence to treatment in neurology.
abstract: OBJECTIVE
  Many effective medical therapies are available for treating neurological diseases, but these therapies tend to be expensive and adherence is critical to their effectiveness. We used patient-reported data to examine the frequency and determinants of financial barriers to medication adherence among individuals treated for neurological disorders.
  
  
  METHODS
  Patients completed cross-sectional surveys on iPads as part of routine outpatient care in a neurology clinic. Survey responses from a 3-month period were collected and merged with administrative sources of demographic and clinical information (eg, insurance type). We explored the association between patient characteristics and patient-reported failure to refill prescription medication due to cost in the previous 12 months, termed here as "nonadherence".
  
  
  RESULTS
  The population studied comprised 6075 adults who were presented between July and September 2015 for outpatient neurology appointments. The mean age of participants was 56 (standard deviation: 18) years, and 1613 (54%) were females. The patients who participated in the surveys (2992, 49%) were comparable to nonparticipants with respect to gender and ethnicity but more often identified English as their preferred language (94% vs 6%,p<0.01). Among respondents, 9.8% (n=265) reported nonadherence that varied by condition. These patients were more frequently Hispanic (16.7% vs 9.8% white,p=0.01), living alone (13.9% vs 8.9% cohabitating,p<0.01), and preferred a language other than English (15.3% vs 9.4%,p=0.02).
  
  
  CONCLUSIONS
  Overall, the magnitude of financial barriers to medication adherence appears to vary across neurological conditions and demographic characteristics.
authors.affiliation: Department of Neurology.
authors.forename: Lidia Mvr
authors.initials: LM
authors.lastname: Moura
authors.affiliation: Department of Neurology.
authors.forename: Eli L
authors.initials: EL
authors.lastname: Schwamm
authors.affiliation: Department of Neurology.
authors.forename: Valdery
authors.initials: V
authors.lastname: Moura Junior
authors.affiliation: Department of Neurology.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Seitz
authors.affiliation: Department of Neurology.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Hoch
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital; Department of Medicine and Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Hsu
authors.affiliation: Department of Neurology.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
keywords: adherence; cost; outcomes