Use of community health workers to improve medication adherence and appointment adherence in a low income, pediatric, urban Hispanic population

Medication non-adherence is an important health concern, with 20 – 30% of prescriptions going unfilled and about 50% of filled medications having incorrect administration.   Medication non-adherence is linked to increased hospital admissions, health care costs, and decreased quality of life.  Similarly, appointment non-adherence is considered to have a negative impact on a person’s health; however there have been few, if any, studies quantifying the impact of appointment non-adherence. 

To improve compliance in a primarily low income, pediatric, urban Hispanic population a local non-profit health insurance plan assigns community health workers (CHW) to clients to provide education, outreach, and support in managing their health conditions.  The CHW develops a pathway model in consultation with the patient to identify barriers to adherence and to develop action steps for improving adherence.  Motivational interviewing techniques are also used.

In this study, up to 100 patients are enrolled and are classified as medication or appointment non-adherent.  Demographic data are collected.  Pre- and post-test data are collected on the ability of the parent to understand the child’s health condition and to understand the physician’s orders.  Data on the agreed upon pathway barriers, interventions, and outcomes are collected.  Additional data on visits, interventions, and outcomes are gathered.  Quantitative analyses are performed to identify relationships between interventions, outcomes, and non-adherence.  In addition, statistical analyses identify potential relationships based on patient demographics, barriers to adherence, and interventions to overcome non-adherence.  Qualitative data are collected from the pediatrician, patient, and CHW on the pathway model and usefulness of the intervention.