Adherence to Medication Regimens Among Low-Income Patients with Multiple Comorbid Chronic Conditions (Report‪)‬

Understanding the illness experience from the point of view of patients who have multiple chronic conditions and are managing multiple medications is an area that has had some research attention, but the complexity and scope of the issue begs for additional examination, especially in an aging population (Bayliss, Steiner, Fernald, Crane, & Main, 2003; Dowell & Hudson, 1997; Moen et al., 2009). One in four U.S. citizens lives with two or more chronic conditions, and by age 65, the prevalence rises to almost 70 percent (Anderson & Horvath, 2004). Almost all of these individuals who seek medical care are treated with multiple prescribed medications (Anderson & Horvath, 2004), but nonadherence is highly prevalent, especially when multiple medications are taken for each co-occurring medical illness (Beusterien, Davis, Flood, Howard, & Jordan, 2008; Roter et al., 1998). Evidence-based guidelines, usually crafted for one disease, often recommend several medications that result in potentially very complex regimens with conflicting directives in people with multiple comorbid conditions. Patients who take multiple medications tend to incur higher out-of-pocket medication costs (Mojtabai & Olfson, 2003), are reluctant to take multiple medications and have a preference to minimize medicine intake (Pound et al., 2005), experience drug interactions that may result in hospitalizations (Winterstein, Sauer, Hepler, & Poole, 2002), and have a higher likelihood of incurring inpatient admissions (Wolff, Starfield, & Anderson, 2002). These effects, which are more pronounced in economically disadvantaged, minority populations with fewer resources (Kaplan, Bhalodkar, Brown,White, & Brown, 2004; Shenolikar, Balkrishnan, Camacho, Whitmire, & Anderson, 2006), may lead to poor adherence and adverse health outcomes (Mojtabai & Olfson, 2003). Indeed, in a population-based study of medication adherence, one out of five low-income patients did not fill all their prescriptions because of cost and skipped doses to make their prescriptions last longer (Safran et al., 2002). Trust also plays a role in medication adherence; those with low trust in their physician are more likely to forgo medicines because of cost (Piette, Heisler, Krein, & Kerr, 2005).