Failure to access prescribed pharmaceuticals by older patients with chronic conditions
Ian McRae A D , Kees van Gool B , Jane Hall B , Laurann Yen C and Michael Wright BA Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Florey, Building 54, Mills Road, Canberra, ACT 0200, Australia.
B Centre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Building 5 Block D, 1–59 Quay Street, Haymarket, NSW 2000, Australia. Email: kees.vangool@uts.edu.au; jane.hall@uts.edu.au; michael.wright@uts.edu.au
C Department of Health Services Research and Policy Research, School of Population Health, The Australian National University, 62A Mills Road, Canberra, ACT 0200, Australia. Email: laurann.yen@anu.edu.au
D Corresponding author. Email: ian.s.mcrae@anu.edu.au
Australian Health Review 44(2) 270-276 https://doi.org/10.1071/AH18146
Submitted: 16 July 2018 Accepted: 30 November 2018 Published: 4 March 2019
Abstract
Objective Medication adherence is a significant public health concern. Australian studies of statins show patients facing the highest copayments are the least likely to be adherent. This study examined whether the association identified between adherence and costs for statins also applies to a wider group of medications prescribed for Australian patients with chronic conditions.
Methods Data from 267 086 participants in the Sax Institute’s 45 and Up Study linked to data from the Pharmaceutical Benefits Scheme (PBS) provided by the Department of Human Services were used. Patients using angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, glitazones and bisphosphonates were identified and classified according to concessional status and whether they had access to the PBS ‘safety net’. Data were analysed using mainly descriptive methods to investigate the association of adherence with cost and other selected covariates.
Results Across medications, the group facing the highest copayment was least adherent. Speaking a language other than English at home and facing high levels of psychological distress were also associated with lower levels of adherence.
Conclusions As for statins, the main financial determinant of adherence is cost in the form of prescribed copayments, suggesting that this may apply across many medications.
What is known about the topic? Previous studies have shown patients’ concern about the costs of pharmaceuticals, and more detailed studies of statins show that the lowest adherence relates to patients facing the highest copayments.
What does this paper add? This paper provides support for the contention that the results found for statins broadly apply across more medications used by people with chronic conditions.
What are the implications for practitioners? Although practitioners cannot affect legislated copayments, they can consider the costs of options for medications for patients with chronic conditions, especially those general patients who have not reached the safety net, and they can be aware that patients from homes where English is not spoken and patients with high levels of psychological distress are also likely to have low adherence without intervention.
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