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Factors associated with medication refill adherence in cardiovascular-related diseases

A focus on health literacy

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Abstract

BACKGROUND: The factors influencing medication adherence have not been fully elucidated. Inadequate health literacy skills may impair comprehension of medical care instructions, and thereby reduce medication adherence.

OBJECTIVES: To examine the relationship between health literacy and medication refill adherence among Medicare managed care enrollees with cardiovascular-related conditions.

RESEARCH DESIGN: Prospective cohort study.

SUBJECTS: New Medicare enrollees from 4 managed care plans who completed an in-person survey and were identified through administrative data as having coronary heart disease, hypertension, diabetes mellitus, and/or hyperlipidemia (n=1,549).

MEASURES: Health literacy was determined using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). Prospective administrative data were used to calculate the cumulative medication gap (CMG), a valid measure of medication refill adherence, over a 1-year period. Low adherence was defined as CMG ≥ 20%.

RESULTS: Overall, 40% of the enrollees had low refill adherence. Bivariate analyses indicated that health literacy, race/ethnicity, education, and regimen complexity were each related to medication refill adherence (P<.05). In unadjusted analysis, those with inadequate health literacy skills had increased odds (odds ratio [OR]=1.37, 95% confidence interval [CI]: 1.08 to 1.74) of low refill adherence compared with those with adequate health literacy skills. However, the OR for inadequate health literacy and low refill adherence was not statistically significant in multivariate analyses (OR=1.23, 95% CI: 0.92 to 1.64).

CONCLUSIONS: The present study suggests, but did not conclusively demonstrate, that low health literacy predicts poor refill adherence. Given the prevalence of both conditions, future research should continue to examine this important potential association.

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Correspondence to Julie A. Gazmararian PhD, MPH.

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This research was supported by an unrestricted grant from Pfizer and from a grant from the Aetna Foundation and the Quality Care Research Fund. Dr. Kripalani receives support from a K23 Mentored Patient-Oriented Research Career Development Award (1 K23 HL077597). While conducting the present research, he was previously supported by the Emory Mentored Clinical Research Scholars Program (NIH/NCRR K12 RR017643).

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Gazmararian, J.A., Kripalani, S., Miller, M.J. et al. Factors associated with medication refill adherence in cardiovascular-related diseases. J GEN INTERN MED 21, 1215–1221 (2006). https://doi.org/10.1111/j.1525-1497.2006.00591.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00591.x

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