Non-affluent diabetes patients risk medication discontinuation
MedWire News: Economically disadvantaged patients with diabetes who are exempt from medication fees are more likely than their fee-paying peers to discontinue oral hypoglycemic agents (OHAs), results of a large Chinese cohort study show.
"It has been argued that low health literacy level, low perceived susceptibility to the consequence of suboptimal control of diabetes, and reduced capability of acting on health care information could attribute to the higher discontinuation rates among the socioeconomically underprivileged," Martin Wong (Chinese University of Hong Kong) and colleagues say.
The team's study examined data on 28,773 diabetes patients recruited in Hong Kong between January 2004 and June 2007, then followed up 6 months later regarding medication use.
The researchers explain that there were 6835 (24%) medication "fee waivers" in the cohort - patients receiving social security allowances from the government. To qualify for fee waiving, patients' inability to pay for consultation fees had been evaluated by a medical social worker who assessed their financial status.
Wong and colleagues report that 2592 (9.9%) patients discontinued their OHA medications within 180 days of receiving their prescriptions.
In logistic regression analysis, fee-payers were less likely to discontinue their medication than their fee-waiving peers (odds ratio [OR]=0.81), as were those with fewer comorbidities (OR=0.59 for two or fewer comorbidities vs more than two).
Wong et al suggest that "the health belief model may explain this observation - namely that they perceive their need to take medication was lower than those with more concomitant diseases and hence sicker."
Lastly, patients attending for their first clinic visit were more likely to be discontinuers than those attending for follow-up visits (OR=0.51).
"It has been suggested that newly treated patients may be relatively asymptomatic - the medications prescribed do not provide immediate feedback on symptom alleviation, and that they may not appreciate the importance of medication adherence," Wong et al comment in the journal Diabetes Research and Clinical Practice.
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By Andrew Czyzewski