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Racial Disparities in Medication Adherence Continue Despite Policy Improvements, According to UTHSC Researchers

Mustafa Hussein, PhD
Mustafa Hussein, PhD

Even though most people know that taking medication properly is key to managing chronic disease, they don’t or can’t always do it. However, the launch of the Medicare Part D prescription drug benefit in 2006 has encouraged more elderly patients to take their heart medications as prescribed.

The long-standing gap between white and minority patients in cardiovascular medication adherence has narrowed. That good news is tempered by findings that African-American seniors are still less likely to adhere to medication goals than Hispanic Medicare participants, and both groups lag white seniors in the rate of adherence in using the common drugs that treat high blood pressure and heart failure.

That’s according to a study by researchers from the University of Tennessee Health Science Center (UTHSC) presented at a recent scientific session of the American Heart Association (AHA).

In June, the same month he successfully defended his dissertation in the UTHSC College of Graduate Health Science’s Health Outcomes and Policy Research Program, Mustafa Hussein, PhD, presented the research on racial disparities in medication adherence at the AHA’s Quality of Care and Outcomes Research 2014 Scientific Sessions. The research was highlighted in a news release from the meeting, and has been published in almost three dozen health, science and medical publications.

“Adherence to medications is crucial for optimal outcomes in patients with cardiovascular disease,” said Dr. Hussein, who was lead author of the study and presented a poster about it at the meeting. “Minorities have a higher burden of cardiovascular disease. But historically, racial minorities are less likely to take medications properly because of socioeconomic and environmental factors.”

Study co-authors are Teresa Waters, PhD, professor in the Department of Preventive Medicine at UTHSC; David K. Solomon, PharmD, professor in the Department of Clinical Pharmacy at UTHSC; and Lawrence Brown, PharmD, PhD, formerly of UTHSC and now professor of Pharmacoeconomics and Health Policy at Chapman University.

“I wanted to study racial disparities in adherence and how a major policy change, such as the introduction of Medicare Part D, affected them,” Dr. Hussein said. Medicare Part D, introduced in 2003 and implemented in 2006, aimed to improve access to prescription drugs and gave special attention to low-income beneficiaries.

The analysis of prescription drug adherence looked at national data from 2002, prior to the introduction of Medicare Part D, through 2010, four years after it was implemented. Overall, adherence among Hispanic seniors improved by about 60 percent, adherence among whites improved 47 percent, but adherence among African-Americans improved by only about 9 percent, Dr. Hussein said.

Hispanics may have more readily responded to aspects of Medicare Part D that encourage medication adherence because they are more likely to live in areas of the country that already had better low-income prescription drug plans even before the benefit was introduced. They appear to have been better primed to use it, he said.

“Even after the introduction of Part D, there are still significant disparities in adherence, and those disparities are large and exist among all sub-groups,” he said. “They are especially large among the dually eligible beneficiaries, those who are receiving Medicaid as well as Medicare, and that can do a lot of harm to final health outcomes.”

Dr. Hussein, who is now a postdoctoral fellow at the School of Public Health at Drexel University in Philadelphia, said the goal behind the numbers is to find solutions that encourage better medication adherence among all populations. “There are currently some impediments in the Medicare Part D program that might be exacerbating those disparities,” he said. Health policymakers should look for more equitable criteria for medication therapy management program eligibility, find ways to improve personal health literacy and confidence, and establish programs to encourage individual ability to keep track of medications.