Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities
01 Jul 2015-Journal of Primary Care & Community Health (SAGE Publications)-Vol. 6, Iss: 3, pp 154-161
TL;DR: Homeless and vulnerably housed individuals face significant barriers to medication adherence and health care providers serving this population should be particularly attentive to nonadherence among younger patients and those with harmful or hazardous drinking patterns.
Abstract: Objectives: Medication adherence is an important determinant of successful medical treatment. Marginalized populations, such as homeless and vulnerably housed individuals, may face substantial barr...
Citations
More filters
TL;DR: Practical, patient-centered strategies for addressing challenges in the management of established CVD in homeless adults, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.
98 citations
TL;DR: HIV infection, injection drug use, and heavy drinking were noted across multiple studies as risk factors for infection with vector-borne and zoonotic pathogens as well as documented exposure to rodent-borne zoonoses among urban homeless and marginalized people.
Abstract: Introduction: In high-income countries, homeless individuals in urban areas often live in crowded conditions with limited sanitation and personal hygiene. The environment of homelessness in high-income countries may result in intensified exposure to ectoparasites and urban wildlife, which can transmit infections. To date, there have been no systematic evaluations of the published literature to assess vector-borne and zoonotic disease risk to these populations. Objectives: The primary objectives of this study were to identify diversity, prevalence, and risk factors for vector-borne and zoonotic infections among people experiencing homelessness and extreme poverty in urban areas of high-income countries. Methods: We conducted a systematic review and narrative synthesis of published epidemiologic studies of zoonotic and vector-borne infections among urban homeless and very poor people in the United States and Europe from 1990 to 2014. Results: Thirty-one observational studies and 14 case studies wer...
62 citations
Cites background from "Barriers to Prescription Medication..."
...Limited access to healthcare and poor medication adherence in these populations contribute to poor outcomes (Kushel et al. 2001, Kessell et al. 2006, Hunter et al. 2015, Surratt et al. 2015)....
[...]
TL;DR: There are significant disparities in in-hospital care and mortality between homeless and nonhomeless adults with cardiovascular conditions and a need for public health and policy efforts to support hospitals that care for homeless persons to reduce disparities.
Abstract: Importance Cardiovascular disease is a major cause of death among homeless adults, with mortality rates that are substantially higher than in the general population. It is unknown whether differences in hospitalization-related care contribute to these disparities in cardiovascular outcomes. Objective To evaluate differences in intensity of care and mortality between homeless and nonhomeless individuals hospitalized for cardiovascular conditions (ie, acute myocardial infarction, stroke, cardiac arrest, or heart failure). Design, Setting, and Participants This retrospective cross-sectional study included all hospitalizations for cardiovascular conditions among homeless adults (n = 24 890) and nonhomeless adults (n = 1 827 900) 18 years or older in New York, Massachusetts, and Florida from January 1, 2010, to September 30, 2015. Statistical analysis was performed from February 6 to July 16, 2019. Main Outcomes and Measures Risk-standardized diagnostic and therapeutic procedure rates and in-hospital mortality rates. Results Of the 1 852 790 total hospitalizations for cardiovascular conditions across 525 hospitals, 24 890 occurred among patients who were homeless (11 452 women and 13 438 men; mean [SD] age, 65.1 [14.8] years) and 1 827 900 occurred among patients who were not homeless (850 660 women and 977 240 men; mean [SD] age, 72.1 [14.6] years). Most hospitalizations among homeless individuals were primarily concentrated among 11 hospitals. Homeless adults were more likely than nonhomeless adults to be black (38.6% vs 15.6%) and insured by Medicaid (49.3% vs 8.5%). After accounting for differences in demographics (age, sex, and race/ethnicity), insurance payer, and clinical comorbidities, homeless adults hospitalized for acute myocardial infarction were less likely to undergo coronary angiography compared with nonhomeless adults (39.5% vs 70.9%;P Conclusions and Relevance There are significant disparities in in-hospital care and mortality between homeless and nonhomeless adults with cardiovascular conditions. There is a need for public health and policy efforts to support hospitals that care for homeless persons to reduce disparities in hospital-based care and improve health outcomes for this population.
57 citations
TL;DR: A qualitative descriptive study through the lens of a transformative framework was used to identify barriers and facilitators to accessing health care as perceived by people experiencing homelessness in the regional municipality of Niagara, Canada.
Abstract: Persons struggling with housing remain significantly disadvantaged when considering access to health care. Effective advocacy for their needs will require understanding the factors which impact their health care, and which of those most concern patients themselves. A qualitative descriptive study through the lens of a transformative framework was used to identify barriers and facilitators to accessing health care as perceived by people experiencing homelessness in the regional municipality of Niagara, Canada. In-person, semi-structured interviews with 16 participants were completed, and inductive thematic analysis identified nine barriers and eight facilitators. Barriers included affordability, challenges finding primary care, inadequacy of the psychiatric model, inappropriate management, lack of trust in health care providers, poor therapeutic relationships, systemic issues, and transportation and accessibility. Facilitators included accessibility of services, community health care outreach, positive relationships, and shelters coordinating health care. Knowledge of the direct experiences of marginalized individuals can help create new health policies and enhance the provision of clinical care.
45 citations
TL;DR: Mental illness, chronic pain, and addictions issues were believed by participants to be poorly treated due to clinician bias at the primary, emergency, and acute care levels.
Abstract: Objective: To determine how accessible health care services are for people who are experiencing homelessness and to understand from their perspectives what impact clinician bias has on the treatment they receive. Methods: Narrative interviews were conducted with 53 homeless/vulnerably housed individuals in Ontario, Canada. Visit history records were subsequently reviewed at 2 local hospitals, for 52 of the interview participants. Results: Of the 53 participants only 28% had a primary care provider in town, an additional 40% had a provider in another town, and 32% had no access to a primary care provider at all. A subset of the individuals were frequent emergency department users, with 15% accounting for 75% of the identified hospital visits, primarily seeking treatment for mental illness, pain, and addictions. When seeking primary care for these 3 issues participants felt medication was overprescribed. Conversely, in emergency care settings participants felt prejudged by clinicians as being drug-seekers. Participants believed they received poor quality care or were denied care for mental illness, chronic pain, and addictions when clinicians were aware of their housing status. Conclusion: Mental illness, chronic pain, and addictions issues were believed by participants to be poorly treated due to clinician bias at the primary, emergency, and acute care levels. Increased access to primary care in the community could better serve this marginalized population and decrease emergency department visits but must be implemented in a way that respects the rights and dignity of this patient population.
29 citations
References
More filters
TL;DR: Strategies to assess and enhance medication adherence (or compliance) are reviewed, to help patients adhere to prescribed treatment regimens and avoid stigmatization.
Abstract: The full benefit of many effective medications will be achieved only if patients adhere to prescribed treatment regimens. Unfortunately, applying terms such as “noncompliant” and “nonadherent” to patients who do not consume every pill at the desired time can stigmatize them in their future relationships with health care providers. This article on medication adherence (or compliance) reviews strategies to assess and enhance this important aspect of patient care.
7,204 citations
"Barriers to Prescription Medication..." refers background in this paper
...denying the severity of a health problem are reasons commonly cited in the general population.(1,2) However, other reasons may indicate barriers related to housing status, such as not having regular access to a doctor, lacking a safe place to store medications, or having competing priorities....
[...]
...Medication adherence, or the extent to which patients take prescribed medications, is an important determinant of successful medical treatment.(1,2) One meta-analysis found an average treatment adherence rate of 75....
[...]
01 Jan 2001
TL;DR: This manual introduces the AUDIT, the Alcohol Use Disorders Identification Test, and describes how to use it to identify persons with hazardous and harmful patterns of alcohol consumption.
Abstract: This manual introduces the AUDIT, the Alcohol Use Disorders Identification Test, and describes how to use it to identify persons with hazardous and harmful patterns of alcohol consumption.
6,150 citations
"Barriers to Prescription Medication..." refers methods in this paper
...A positive screen is defined as a score of ≥8 and is indicative of hazardous or harmful drinking.(21) Drug abuse and drug-related problems were assessed using the Drug Abuse Screening Test (DAST10)....
[...]
TL;DR: In this paper, a comprehensive report entitled Adherence to Long-Term Therapies: Evidence for Action w1x was published, focusing on nine chronic conditions and their risk factors.
Abstract: The World Health Organization(WHO) has recently published a comprehensive report entitled Adherence to Long-Term Therapies: Evidence for Action w1x. This report focuses on nine chronic conditions and their riskfactors. The conditions reviewed are hypertension, tobacco smoking cessation, asthma, cancer (palliative care), depression, diabetes, epilepsy, HIV yAIDS and tuberculosis. The report reviewed the available literature on the epidemiology of nonadherence worldwide; it stressed the multi-factorial nature of nonadherence, it identified health systems and health care teams as significant determinants to good adherence and discussed the health and economic consequences of nonadherence as well as some strategies for improving it. This report has major relevance for cardiovascular nurses. Cardiovascular disease is and will remain a major challenge for health care professionals and health care systems, and it contributes significantly to the global burden of disease in both developed and developing countriesw2x. Nonadherence to treatment recommendations in patients with cardiovascular risk-factors as well as patients with cardiovascular disease is widespread, and it is a major factor contributing to poor outcome. Nurses are excellently positioned to target the behavioral dimension of chronic disease management. They can improve outcomes by developing and implementing adherence-enhancing strategies to reduce cardiovascular risk-factors, and to enhance adherence with non-smoking, diet, exercise and medication regimens w3x. The value of this WHO report is not only that it comprehensively reviews the current state of the literature including hypertension and tobacco smoking cessation, but also it highlights the need for a multi-disciplinary approach to adherence, emphasizes system factors that need to be addressed in successfully implementing adherence-enhancing strategies. Moreover, it also provides illustrative examples of the ways in which professionals have contributed in their own fields of expertise including cardiovascular care among other fields. This report, therefore, provides an instrument to cardiovascular nurses to expand the behavioral dimension of their patient management strategies, to teach students at undergraduate and graduate level, to guide their research endeavors, to guide policy makers, ultimately with the goal to improve outcomes of populations.
4,049 citations
TL;DR: An algorithm which automates the purposeful selection of covariates within which an analyst makes a variable selection decision at each step of the modeling process and has the capability of retaining important confounding variables, resulting potentially in a slightly richer model.
Abstract: Background
The main problem in many model-building situations is to choose from a large set of covariates those that should be included in the "best" model. A decision to keep a variable in the model might be based on the clinical or statistical significance. There are several variable selection algorithms in existence. Those methods are mechanical and as such carry some limitations. Hosmer and Lemeshow describe a purposeful selection of covariates within which an analyst makes a variable selection decision at each step of the modeling process.
2,577 citations
"Barriers to Prescription Medication..." refers methods in this paper
...Multivariate models were constructed using a purposeful selection technique.(24) After generating univariate logistic regression models for each covariate against each outcome of interest, variables that met the inclusion criteria (P ≤ ....
[...]
TL;DR: This review offers insights into the literature on patient adherence, providing direction for future research, and focuses on reliability and validity of adherence measurement and systematic study of substantive and methodologic moderators.
Abstract: BackgroundThe literature on patient adherence to treatment includes hundreds of empirical studies. A comprehensive examination of the findings requires the organization and quantification that is possible with meta-analysis.ObjectivesThe goals of this research are retrieval, compilation, and averagi
2,199 citations
"Barriers to Prescription Medication..." refers background in this paper
...denying the severity of a health problem are reasons commonly cited in the general population.(1,2) However, other reasons may indicate barriers related to housing status, such as not having regular access to a doctor, lacking a safe place to store medications, or having competing priorities....
[...]
...Medication adherence, or the extent to which patients take prescribed medications, is an important determinant of successful medical treatment.(1,2) One meta-analysis found an average treatment adherence rate of 75....
[...]