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Financial Strain and Medication Adherence among Diabetes Patients in an Integrated Health Care Delivery System: The Diabetes Study of Northern California (DISTANCE)

Keywords: Adherence; diabetes; managed care; cost of care.

Objective: To examine self-reported financial strain in relation to pharmacy utilization adherence data.

Data Sources/Study Setting: Survey, administrative, and electronic medical data from Kaiser Permanente Northern California.

Study Design: Retrospective cohort design (2006, n = 7,773).

Data Collection/Extraction Methods: We compared survey self-reports of general and medication-specific financial strain to three adherence outcomes from pharmacy records, specifying adjusted generalized linear regression models.

Principal Findings: Eight percent and 9 percent reported general and medication-specific financial strain. In adjusted models, general strain was significantly associated with primary nonadherence (RR = 1.37; 95 percent CI: 1.04–1.81) and refilling late (RR = 1.34; 95 percent CI: 1.07–1.66); and medication-specific strain was associated with primary nonadherence (RR = 1.42, 95 percent CI: 1.09–1.84).

Conclusions: Simple, minimally intrusive questions could be used to identify patients at risk of poor adherence due to financial barriers.

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