Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities
Objectives: Medication adherence is an important determinant of successful medical treatment. Marginalized populations, such as homeless and vulnerably housed individuals, may face substantial barriers to medication adherence. This study aimed to determine the prevalence of, reasons for, and factors...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
SAGE Publishing
2015-07-01
|
Series: | Journal of Primary Care & Community Health |
Online Access: | https://doi.org/10.1177/2150131914560610 |
id |
doaj-14e336c53a93400780bf4ceba2b80a1d |
---|---|
record_format |
Article |
spelling |
doaj-14e336c53a93400780bf4ceba2b80a1d2020-11-25T04:03:12ZengSAGE PublishingJournal of Primary Care & Community Health2150-13192150-13272015-07-01610.1177/2150131914560610Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian CitiesCharlotte E. Hunter0Anita Palepu1Susan Farrell2Evie Gogosis3Kristen O’Brien4Stephen W. Hwang5Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, CanadaCentre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, Vancouver, British Columbia, CanadaUniversity of Ottawa, Institute of Mental Health Research, Ottawa, Ontario, CanadaCentre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, CanadaCentre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, CanadaDivision of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, CanadaObjectives: Medication adherence is an important determinant of successful medical treatment. Marginalized populations, such as homeless and vulnerably housed individuals, may face substantial barriers to medication adherence. This study aimed to determine the prevalence of, reasons for, and factors associated with medication nonadherence among homeless and vulnerably housed individuals. Additionally, we examined the association between medication nonadherence and subsequent emergency department utilization during a 1-year follow-up period. Methods: Data were collected as part of the Health and Housing in Transition study, a prospective cohort study tracking the health and housing status of 595 homeless and 596 vulnerably housed individuals in 3 Canadian cities. Logistic regression was used to identify factors associated with medication nonadherence, as well as the association between medication nonadherence at baseline and subsequent emergency department utilization. Results: Among 716 participants who had been prescribed a medication, 189 (26%) reported nonadherence. Being ≥40 years old was associated with decreased likelihood of nonadherence (adjusted odds ratio [AOR] = 0.59; 95% confidence interval [CI] = 0.41-0.84), as was having a primary care provider (AOR = 0.49; 95% CI = 0.34-0.71). Having a positive screen on the AUDIT (Alcohol Use Disorders Identification Test; an indication of harmful or hazardous drinking) was associated with increased likelihood of nonadherence (AOR = 1.86; 95% CI = 1.31-2.63). Common reasons for nonadherence included side effects, cost, and lack of access to a physician. Self-reported nonadherence at baseline was significantly associated with frequent emergency department use (≥3 visits) over the follow-up period at the bivariate level (OR = 1.55; 95% CI = 1.02-2.35) but was not significant in a multivariate model (AOR = 1.49; 95% CI = 0.96-2.32). Conclusion: Homeless and vulnerably housed individuals face significant barriers to medication adherence. Health care providers serving this population should be particularly attentive to nonadherence among younger patients and those with harmful or hazardous drinking patterns.https://doi.org/10.1177/2150131914560610 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Charlotte E. Hunter Anita Palepu Susan Farrell Evie Gogosis Kristen O’Brien Stephen W. Hwang |
spellingShingle |
Charlotte E. Hunter Anita Palepu Susan Farrell Evie Gogosis Kristen O’Brien Stephen W. Hwang Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities Journal of Primary Care & Community Health |
author_facet |
Charlotte E. Hunter Anita Palepu Susan Farrell Evie Gogosis Kristen O’Brien Stephen W. Hwang |
author_sort |
Charlotte E. Hunter |
title |
Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities |
title_short |
Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities |
title_full |
Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities |
title_fullStr |
Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities |
title_full_unstemmed |
Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities |
title_sort |
barriers to prescription medication adherence among homeless and vulnerably housed adults in three canadian cities |
publisher |
SAGE Publishing |
series |
Journal of Primary Care & Community Health |
issn |
2150-1319 2150-1327 |
publishDate |
2015-07-01 |
description |
Objectives: Medication adherence is an important determinant of successful medical treatment. Marginalized populations, such as homeless and vulnerably housed individuals, may face substantial barriers to medication adherence. This study aimed to determine the prevalence of, reasons for, and factors associated with medication nonadherence among homeless and vulnerably housed individuals. Additionally, we examined the association between medication nonadherence and subsequent emergency department utilization during a 1-year follow-up period. Methods: Data were collected as part of the Health and Housing in Transition study, a prospective cohort study tracking the health and housing status of 595 homeless and 596 vulnerably housed individuals in 3 Canadian cities. Logistic regression was used to identify factors associated with medication nonadherence, as well as the association between medication nonadherence at baseline and subsequent emergency department utilization. Results: Among 716 participants who had been prescribed a medication, 189 (26%) reported nonadherence. Being ≥40 years old was associated with decreased likelihood of nonadherence (adjusted odds ratio [AOR] = 0.59; 95% confidence interval [CI] = 0.41-0.84), as was having a primary care provider (AOR = 0.49; 95% CI = 0.34-0.71). Having a positive screen on the AUDIT (Alcohol Use Disorders Identification Test; an indication of harmful or hazardous drinking) was associated with increased likelihood of nonadherence (AOR = 1.86; 95% CI = 1.31-2.63). Common reasons for nonadherence included side effects, cost, and lack of access to a physician. Self-reported nonadherence at baseline was significantly associated with frequent emergency department use (≥3 visits) over the follow-up period at the bivariate level (OR = 1.55; 95% CI = 1.02-2.35) but was not significant in a multivariate model (AOR = 1.49; 95% CI = 0.96-2.32). Conclusion: Homeless and vulnerably housed individuals face significant barriers to medication adherence. Health care providers serving this population should be particularly attentive to nonadherence among younger patients and those with harmful or hazardous drinking patterns. |
url |
https://doi.org/10.1177/2150131914560610 |
work_keys_str_mv |
AT charlotteehunter barrierstoprescriptionmedicationadherenceamonghomelessandvulnerablyhousedadultsinthreecanadiancities AT anitapalepu barrierstoprescriptionmedicationadherenceamonghomelessandvulnerablyhousedadultsinthreecanadiancities AT susanfarrell barrierstoprescriptionmedicationadherenceamonghomelessandvulnerablyhousedadultsinthreecanadiancities AT eviegogosis barrierstoprescriptionmedicationadherenceamonghomelessandvulnerablyhousedadultsinthreecanadiancities AT kristenobrien barrierstoprescriptionmedicationadherenceamonghomelessandvulnerablyhousedadultsinthreecanadiancities AT stephenwhwang barrierstoprescriptionmedicationadherenceamonghomelessandvulnerablyhousedadultsinthreecanadiancities |
_version_ |
1724441185295007744 |