Understanding situations where people report cost-related medication nonadherence (CRN): A qualitative study.

摘要

Around 20% of the US population reports not acquiring a prescription because of cost, also referred to as cost-related medication nonadherence (CRN) leading to obvious adverse health effects. However, given how those with relatively high incomes report CRN, and given research evidence that people often have reasons for being nonadherent even with acquired medications, and given that many other factors affect health behavior, it seems likely that other factors may be playing a substantial role in medication-access decisions for those who report CRN.;The main research objective was to gain better understanding of what people are experiencing in situations in which they would report CRN.;A grounded theory approach was used to better understand what happens when people report CRN. The data from which the framework was based was gathered by interviewing 21 clients at a clinic serving the under-insured who reported CRN. Data coding, analysis, and framework development were performed by the primary investigator and a second independent, with the resulting framework representing the primary investigator’s compiling of the two separate ones.;A framework that describes what happens when people report CRN was developed. People were able to initially acquire their medication only if they were offered help in acquiring it, were willing to access known sources of help, or if they were willing to pay the given cost. For those not able to initially acquire their medication, whether or not they sought help depended on their belief in what help was available, and in a re-evaluation of how much they needed the medication. The vast majority of those who sought help eventually received help and were able to acquire their medication. Those who did not seek out help either lived without or substituted with an alternative.;Reporting of CRN is not really a one-time event, but a dynamic process in which some people are able to eventually acquire their desired medication, with the key factor being whether or not they receive help in doing do. Factors previously shown to affect drug utilization (such as worries about side effects, addiction, regimen complexity, etc.) had little to no effect on whether or not the drug was acquired. This current research improves our understanding of what happens when people report CRN, and will help in the design of programs to improve access to needed medication.