Abstract T P281: Low Household Income and Medication Co-pays are Associated with Higher Risk of Anticipated Medication Non-adherence in a Cross-section of Admitted Stroke Patients
Objectives: Successful secondary stroke prevention is dependent on medication adherence. However, medication non-adherence can be highly variable and results in suboptimal management of risk factors. Our aim was to determine patient-specific barriers to anticipated medication adherence.
Methods: We surveyed patients admitted to a large tertiary hospital with a diagnosis of stroke or TIA from September 2012 to June 2014. Participants were asked: “Are you likely to skip medication doses if you do not believe that the medication will improve your health in the long run?” “Yes” or “maybe” responses were coded as anticipated non-adherence; and “no” was coded as anticipated adherence. Univariate and multivariable logistic regression analyses were performed on demographic characteristics including socioeconomic status (SES) to determine risk factors associated with anticipated non-adherence.
Results: A total of 123 patients were surveyed; mean age 63 (+/-16), 51.2% women, and 71.5% white. Participants with anticipated non-adherence had a mean age 58y vs. 65y for participants with anticipated adherence (p = 0.014). Only 27.7% of white participants admitted anticipated non-adherence compared to 54.3% blacks (p =0.006). Participants who were “home by choice” were more likely to report anticipated adherence (76.6%) vs those who were “home not by choice” (41.2%) or “working” (54%); p= 0.007. Having insurance with no copay or having no insurance was associated with high anticipated adherence (85.7%) compared to having insurance with copay (52.6%; p =0.029). Annual household income < $20,000 was associated with high anticipated non-adherence (54.8%) compared to household income > $35,000 (32.6%; p =0.029). In multivariable logistic regression (adjusted for age, sex and race), anticipated non-adherence was associated with having insurance with copay (OR 21.6, 95% CI 3.6-133.0), household income < $20,000 (OR 5.2, 1.3-21.1) and being home by choice (OR 0.18, 0.04-0.77).
Conclusion: There is a high risk of anticipated non-adherence when patients do not believe that medications will improve their health in the long run. We have identified factors that increase this risk. Awareness of these factors may inform patient-specific strategies to improve adherence.
Author Disclosures: M.K. Arnan: None. C. Bushnell: Research Grant; Significant; World Federation of Neurology support for the International Maternal Newborn Stroke Registry.
- © 2015 by American Heart Association, Inc.