Older Patients’ Perceptions of Medication Importance and Worth
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Background: Cost-related medication non-adherence may be influenced by patients’ perceived importance of their medications.
Objectives: This exploratory pilot study addresses three related but distinct questions: Do patients perceive different levels of importance among their medications? What factors influence perceptions of medication importance? Is perceived importance associated with perceived worth of medications, and does expense impact on that association?
Methods: Study participants included individuals aged ≥60 years who were taking three or more prescription drugs. Semi-structured, in-person interviews were conducted to measure how patients rated their medications in terms of importance, expense and worth. Factors that influenced medication importance were identified using qualitative analysis. Ordinal logistic regression analyses were employed to examine the association between perceived importance and perceived worth of medications, and the impact of expense on that association.
Results: For 143 prescription drugs reported by 20 participants, the weighted mean rating of medication importance was 8.2 (SD 1.04) on a scale from 0 (not important at all) to 10 (most important). Patients considered 38% of these medications to be expensive. The weighted mean rating of worth was 8.4 (SD 1.46) on a scale from 0 (not worth it at all) to 10 (most worth). Three major factors influenced medication importance: drug-related (characteristics, indications, effects and alternatives); patient-related (knowledge, attitudes and health); and external (the media, healthcare and family caregivers, and peers). Regression analyses showed an association between perceived importance and perceived worth for inexpensive medications (odds ratio [OR] 2.23; p = 0.002) and an even greater association between perceived importance and perceived worth for expensive medications (OR 4.29; p < 0.001).
Discussion: This study provides preliminary evidence that elderly patients perceive different levels of importance for their medications based on factors beyond clinical efficacy. Their perception of importance influences how they perceive their medications’ worth, especially for medications of high costs. Understanding how patients perceive medication importance may help in the development of interventions to reduce cost-related non-adherence.
- Briesacher, BA, Gurwitz, JH, Soumerai, SB (2007) Patients at-risk for cost-related medication nonadherence: a review of the literature. J Gen Intern Med 22: pp. 864-71 CrossRef
- Kaufman, DW, Kelly, JP, Rosenberg, L (2002) Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA 287: pp. 337-44 CrossRef
- Heisler, M, Langa, KM, Eby, EL (2004) The health effects of restricting prescription medication use because of cost. Med Care 42: pp. 626-34 CrossRef
- Safran, DG, Neuman, P, Schoen, C (2005) Prescription drug coverage and seniors: findings from a 2003 national survey. Health Affairs.
- Steinman, MA, Sands, LP, Covinsky, KE (2001) Self-restriction of medications due to cost in seniors without prescription coverage. J Gen Intern Med 16: pp. 793-9 CrossRef
- Leibowitz, A, Manning, WG, Newhouse, JP (1985) The demand for prescription drugs as a function of cost-sharing. Soc Sci Med 21: pp. 1063-9 CrossRef
- Lohr, KN, Brook, RH, Kamberg, CJ (1986) Use of medical care in the Rand Health Insurance Experiment: diagnosis- and service-specific analyses in a randomized controlled trial. Med Care 24: pp. S1-87
- Goldman, DP, Joyce, GF, Escarce, JJ (2004) Pharmacy benefits and the use of drugs by the chronically ill. JAMA 291: pp. 2344-50 CrossRef
- Tseng, CW, Brook, RH, Keeler, E (2004) Cost-lowering strategies used by Medicare beneficiaries who exceed drug benefit caps and have a gap in drug coverage. JAMA 292: pp. 952-60 CrossRef
- Harris, BL, Stergachis, A, Ried, LD (1990) The effect of drug copayments on utilization and cost of Pharmaceuticals in a health maintenance organization. Med Care 28: pp. 907-17 CrossRef
- Piette, JD, Heisler, M, Wagner, TH (2004) Cost-related medication underuse among chronically ill adults: the treatments people forgo, how often, and who is at risk. Am J Public Health 94: pp. 1782-7 CrossRef
- Soumerai, SB, Ross-Degnan, D, Avorn, J (1991) Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes. N Engl J Med 325: pp. 1072-7 CrossRef
- Tamblyn, R, Laprise, R, Hanley, JA (2001) Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA 285: pp. 421-9 CrossRef
- Boardman, AE, Greenberg, DH, Vining, AR (1996) Cost-benefit analysis: concepts and practice. Prentice Hall, Upper Saddle River (NJ)
- Mitchell, RC, Carson, RT (1989) Using surveys to value public goods: the contingent value method. Johns Hopkins Press, Baltimore (MD)
- Davis, TC, Long, SW, Jackson, RH (1993) Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med 25: pp. 391-5
- Davis, TC, Michielutte, R, Askov, EN (1998) Practical assessment of adult literacy in health care. Health Educ Behav 25: pp. 613-24 CrossRef
- Glaser, B, Strauss, AL (1967) The discovery of grounded theory: strategies for qualitative research. Aldine, Chicago (IL)
- Gilbert, N (1995) Researching social life. Sage Publications, London
- Miles, MB, Huberman, AM (1994) Qualitative data analysis: an expanded sourcebook. Sage Publications, London
- Long, J, Freese, J (2005) Regression models for categorical outcomes using stata. Stata Press, College Station (TX)
- Tjia, J, Givens, J, Karlawish, J (2008) Beneath the surface: discovering the unvoiced concerns of older adults with type 2 diabetes mellitus. Health Educ Res 23: pp. 40-52 CrossRef
- Guest, G, Bunce, A, Johnson, L (2006) How many interviews are enough? An experiment with data saturation and variability. Field Methods 18: pp. 59-82 CrossRef
- Weiler, SC, Romney, AK (1988) Systematic data collection. Qualitative research methods. Sage Publications, Newbury Park (CA)
- Older Patients’ Perceptions of Medication Importance and Worth
Drugs & Aging
Volume 25, Issue 12 , pp 1061-1075
- Cover Date
- Print ISSN
- Online ISSN
- Springer International Publishing
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Buehler Center on Aging, Health & Society, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- 2. Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- 3. Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
- 4. Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- 5. Medical Sciences Division, University of Oxford, Oxford, UK
- 6. Division of Geriatric Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA