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Seniors May Not be as Bad at Skipping Drugs as Baby
Boomers
New national study reinforces reports that
people are not taking drugs due to cost
 Oct.
7, 2004 A new large-scale study confirms
previous reports that people are not taking their medicine because they
cannot afford it. This study focused on those with chronic conditions
and, although they found seniors with high drugs costs were among the
most likely to skip doses, they also discovered senior citizens were
substantially less likely to cut back on medications due to cost than
those in their 50s.
The nationally representative survey of older
adults finds that 18 percent of those with chronic conditions such as
heart disease and depression skip some of their prescription medicines
because of out-of-pocket cost pressures, and 14 percent do so at least
every month.
Based on the studys findings, the authors estimate
that every month, this cost-related medication skimping leads more than
a million Americans with diabetes to use less medication for that
illness than was prescribed to them, and causes more than 1.6 million
people with asthma to miss some of their doses of medication.
The findings, from a nationally representative
survey of 4,055 adults over the age of 50, are published in the October
issue of the American Journal of Public Health by a team from the
University of Michigan Health System, the Veterans Affairs Ann Arbor
Healthcare System and Stanford University. The study was funded by the
VA.
Not surprisingly, the study finds that seniors
whose out-of-pocket prescription costs are more than $100 a month, and
those with low incomes or no prescription drug coverage, are at the
greatest risk for skimping on their medications.
Other results of the survey indicate that people
with chronic illnesses were more likely to cut back on certain kinds of
medications over others, suggesting that patients are selective about
which drugs they go without.
We found that many patients go without drugs that
relieve serious symptomatic conditions such as back pain or ulcers,
while others skipped drugs that are life-sustaining, such as blood
pressure and cholesterol drugs, but that might not cause any noticeable
difference in day-to-day functioning, says lead author John D. Piette,
a VA Career Scientist and associate professor of internal medicine at
the U-M Medical School.
More patients regularly cut back on costs by
forgoing their medicines for depression, asthma, ulcers, arthritis,
migraines and back pain, for example, than went without medicines for
high blood pressure, high cholesterol or diabetes. Piette and his
colleagues say their findings suggest that changes in prescription drug
benefit policites will affect patients differently depending on their
particular medical problems and possibly their demographic
characteristics as well.
The data add to a growing list of findings on
cost-related prescription drug skimping that have been published by the
same group of researchers in the last few months.
In September, the group reported in the Archives of
Internal Medicine that most chronically ill patients who cut back on
prescription drugs due to cost dont tell their doctors theyre doing
so. And in June, they released the first long-term evidence that
skimping on medications due to cost can lead to adverse health outcomes
for chronically ill patients. In February, they reported that diabetes
patients who forgo medication due to cost pressures have worse blood
sugar control, symptoms and physical functioning.
Were getting a clearer picture of how chronic
illness, out-of-pocket cost, insurance and patient characteristics
combine to create a pattern of non-adherence among older Americans,
says Piette. This is an issue that affects millions of Americans, and
will influence their health for years to come.
No matter which drugs they cut back on, those
patients who reported at least some cost-related adherence problems were
describing a relatively frequent problem. In fact, 78 percent of those
who reported ever having cut back on any medication due to cost in the
last year also said they were forgoing treatment at least once a month.
Having insurance to cover drug costs didnt always
mean patients were always able to stay on their medications, the
researchers found. Thats because cash co-payments and deductibles
required by some insurance plans can add up to hundreds of dollars a
month, especially for the large number of older adults with multiple
chronic illnesses.
When the sample of surveyed adults was weighted to
reflect national population characteristics, the researchers found that
half of all respondents had monthly prescription-related costs of $50 or
more, and 25 percent had monthly costs of $100 or more. Eighty-three
percent of respondents had some form of prescription drug coverage, but
even so, many of these patients reported that their monthly medication
costs topped $100.
Those who didnt have insurance were the least
likely to be able to afford out-of-pocket payments for drugs:
Respondents who had incomes under $20,000 a year were more than twice as
likely to be without drug coverage than those making more than $60,000 a
year.
In general, there were no notable differences in
cost-related medication under-use across groups defined by race, gender
or educational attainment. However, the researchers found that patients
over the age of 65 were substantially less likely to cut back on
medications due to cost than those in their 50s. As a result, Piette
says, planned Medicare reforms will not address the problems of
medication cost pressures for those chronically ill patients who may
need assistance the most: those under age 65.
In the study, the researchers examined risk factors
for cost-related medication under-use separately for patients with the
10 most common chronic health problems. For example, people who had been
prescribed drugs to control their blood pressure were more than four
times as likely to skimp on their medicines if they paid more than $100
a month for all their medications than if they paid less than $100.
Overall, about 7 percent of people with high blood pressure said they
had cut back on their blood pressure medication due to cost at least
once per month.
Similarly, people who had been prescribed drugs to
treat depression were more than four times as likely to say they had cut
back on a medication due to cost if they paid more than $100 a month for
all their medications. And 14 percent of those patients who had
prescriptions for antidepressants cut back on those depression
medications each month due to cost.
In addition to Piette, the studys authors include
Michele Heisler, M.D., M.P.A., also of the VA Ann Arbor Healthcare
System and the U-M Medical School, and Todd H. Wagner, Ph.D., of the VA
Health Economics Resource Center and Stanford University. Reference:
AJPH: Oct. 2004, Vol. 94, No. 10, pp 1782-1787.
Copyright: SeniorJournal.com |
