Patient Financial Stress and Medication Nonadherence

By Victoria Socha - Last Updated: April 11, 2023

According to Dua Abedeen, MPH, and colleagues at SUNY Downstate Health Sciences University, Brooklyn, New York, undue financial stress may force patients to choose between medication and other living expenses, resulting in inferior rates of medication adherence. Unless directly asked, patients may not disclose issues with finances to their provider.

Using a Likert scale survey, the researchers interviewed a random convenience sample of 24 patients receiving dialysis and 16 kidney transplant recipients in an inner-city area. Results of the interviews were reported during a poster session at the National Kidney Foundation Spring Clinical Meetings 2023 in a poster titled Association of Financial Stressors With Medication Nonadherence in Inner-City Patients With ESKD.

Mean age of the interviewed patients was 59 years, 77% (n=30) identified as Black, 70% (n=26) were men, 57% (n=20) had less than a college education, and 65% (n=13) made less than $40,000 per year. Mean dialysis vintage was 5.2 years, and mean time since transplant was 4.0 years. All of the patients had insurance.

More than half of the cohort (52%, n=19) said that finances affected their ability to control their medical condition, 42% (n=15) said they had difficulty meeting monthly bills, and 40% (n=14) reported difficulty in affording housing. Seventeen patients reported forgetting to take medication, five reported intentionally missing a dose, and six reported attempting to make their medication last as long as possible, including skipping a dose.

Patients who reported attempting to make medications last as long as possible had more difficulty in meeting monthly expenses (r=0.365; P=.044) and affording housing (r=0.360; P=.047). Those who reported more difficulty in meeting monthly household payments were more worried about the financial costs associated with their medications (r=0.453; P=.007), as were those who reported more difficulty in affording housing (r=.0456; P=.006).

In summary, the researchers said, “In our inner-city population: 1. Almost half [of patients] had forgotten to take medication and 14% had been intentionally nonadherent. 2. The majority [of patients] believed finances affected their ability to manage their kidney disease. 3. Almost half [of patients] had difficulty with monthly bills and paying for housing. 4. The greater the financial hardship, the more likely patients would skip doses to make medication last longer and [the more likely they were] to feel that they could not control their disease. 5. Housing and other financial difficulties in low-income [end-stage kidney disease (ESKD)] populations may contribute to nonadherence and feelings of helplessness and should be questioned about in order to identify patients at risk so that interventions can be planned.”

Source: Abedeen D, Williams B, Gomez J, Markell M. Association of financial stress with medication nonadherence in inner-city patients with ESKD. Poster #195. Abstract of a poster presented at the National Kidney Foundation Spring Clinical Meetings 2023; April 11-15, 2023; Austin, Texas.

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