Prescription access ineligibility and medication non-compliance

Introduction: Almost all chronic diseases require on-going medical management with prescription medication. Without management, conditions are likely to exacerbate, resulting in poorer health and an increased use of health services. Uninsured lower-income adults with chronic conditions experience difficulty in obtaining medications. This study examines the effect of a stop-gap medication program operated by an urban community health center (CHC) on preventable medical visits in its population of uninsured adult patients with chronic conditions. The Andersen and Aday Model of Health Utilization is employed as a framework to examine the predisposing, enabling and need factors associated with preventable medical visits. Methods: This study is an ongoing longitudinal (90 day) and observational study conducted at the multi-site CHC. Data was initially collected at a random sample of all sites and clinic times; all patients meeting study criteria were invited to participate. The follow-up interviews will be conducted three months later by phone. Data is collected by patient survey and by medical record abstraction. Group membership is determined by ‘stop-gap' program eligibility (stop-gap eligible or ineligible). Survey items are based upon theory, existing tools with established reliability/validity, and an expert panel review. Pre-test data was collected in two waves (total N=421). Overall, 70% of participants are female, 68% are African-American, age range is 45-60 years. The main chronic conditions reported are hypertension, high cholesterol, uncontrolled diabetes and asthma. Almost three-quarters (73%) are eligible for the stop-gap program. Preliminary Results: The two groups (stop-gap eligible and ineligible) have similar demographic, disease and access characteristics. A vast majority in both groups report medication access difficulty in the past year. Almost all (93%) report medication sharing, 89% report not filling a prescription due to cost, and 76% report medication non-compliance due to cost. A large portion (84%) of the 687 calls taken by the triage operators at the CHC were from stop-gap ineligible patients who had been unable to obtain their medications and were experiencing symptoms. In the ineligible group, 47% made appointments during the follow-up period, reporting they were experiencing symptoms and/or were without medications. Preliminary Conclusions: The stop-gap medication program appears to help minimize both symptom flare-ups and health care utilization. Further analyses will examine the extent of the effect of the stop-gap program when other predisposing, need and enabling factors are controlled for. If effective, stop-gap programs could prove to be both cost-saving and health promoting to CHCs and the communities they serve.