178776 Correlates of medication non-adherence among urban African-Americans with type 2 diabetes

Monday, October 27, 2008: 1:30 PM

Chandra L. Jackson, MSc , Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Felicia Hill-Briggs, PhD , Johns Hopkins Medical Institutions, Baltimore, MD
Frederick Brancati, MD, MHS , Department of Medicine & Epidemiology, Johns Hopkins University, Baltimore, MD
Marian Batts-Turner, MSN, RN , The Johns Hopkins Medical Institutions, Baltimore, MD
Hsin-Chieh Yeh, PhD , Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD
Rosemary Dray-Spira, MD, PhD , Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD
Lee Bone, MPH, RN , Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Martha N. Hill, PhD, RN , School of Nursing, Johns Hopkins University, Baltimore, MD
David Levine, MD, MPH, ScD , Department of Medicine, Johns Hopkins University, Baltimore, MD
Tiffany L. Gary, PhD , Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Background: African Americans (AA) have higher rates of diabetes-related complications compared to their white counterparts, and poorer medication adherence may contribute to this disparity. To design more effective interventions and improve health outcomes, there is a need to better understand behaviors associated with medication non-adherence in this population. Research Design and Methods: We conducted a cross-sectional study among 488 AA adults with type 2 diabetes who were participants in Project Sugar 2, a clinic and primary-care based intervention study in an urban managed care organization. Medication adherence was assessed using a measure designed for urban populations of low socioeconomic status (Hill-Bone Compliance scale). The scale consisted of 9 questions evaluating how often participants forgot to take their medication, get prescriptions filled, and how often they missed taking them when they, for example, were being careless, felt better, or sick. A higher score indicates greater non-adherence. HbA1c, blood pressure, and cholesterol levels were also measured. Results: Participants were 73% female, mean ( SD) age 61 11 years, and 35% had annual incomes <$500. Only 287 (59%) reported taking diabetes, blood pressure (BP), and/or cholesterol medications as often as prescribed. Failing to take their medication at least once within 2 weeks, adjusted for age and education, was associated with being forgetful (prevalence ratio=3.53; 95%CI: 2.77-4.51), careless (prevalence ratio=2.56; 95%CI: 2.12-3.10), and deciding not to take prescribed medications (prevalence ratio=2.20; 95%CI: 1.81-2.68). Medication non-adherence, based on a compliance score ≥11 (median: 10, range: 9-36), was significantly associated with poorer BP (≥130/80) (prevalence ratio=1.31; 95%CI: 1.07-1.61) and HbA1c control (≥7%) (prevalence ratio=1.23; 95%CI: 1.01-1.48) after adjusting for age and education. Conclusions: These data suggest that specific behaviors related to medication adherence are important for diabetes control. To improve diabetes care and self-management skills, greater efforts in fostering more behavioral intervention studies focused on patient-level barriers to adherence are warranted in this population.

Learning Objectives:
1) Recognize and articulate correlates of medication non-adherence among low-income African Americans with type 2 diabetes. 2) Tailor future health behavior interventions to better address medication non-adherence among African-Americans.

Keywords: Minorities, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I do not have any conflicts of interest and have taken the lead role in developing the abstract
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.