Abstract
Background
Permanent supportive housing (PSH) programs, which have grown over the last decade, have been associated with changes in health care utilization and spending. However, little is known about the impact of such programs on use of prescription drugs critical for managing chronic diseases prevalent among those with unstable housing.
Objective
To evaluate the effects of PSH on medication utilization and adherence among Medicaid enrollees in Pennsylvania.
Design
Difference-in-differences study comparing medication utilization and adherence between PSH participants and a matched comparison cohort from 7 to 18 months before PSH entry to 12 months post PSH entry.
Subjects
Pennsylvania Medicaid enrollees (n = 1375) who entered PSH during 2011–2016, and a propensity-matched comparison cohort of 5405 enrollees experiencing housing instability who did not receive PSH but received other housing services indicative of episodic or chronic homelessness (e.g., emergency shelter stays).
Main Measures
Proportion with prescription fill, mean proportion of days covered (PDC), and percent adherent (PDC ≥ 80%) for antidepressants, antipsychotics, anti-asthmatics, and diabetes medications.
Key Results
The PSH cohort saw a 4.77% (95% CI 2.87% to 6.67%) relative increase in the proportion filling any prescription, compared to the comparison cohort. Percent adherent among antidepressant users in the PSH cohort rose 7.41% (95% CI 0.26% to 14.57%) compared to the comparison cohort. While utilization increased in the other medication classes among the PSH cohort, differences from the comparison cohort were not statistically significant.
Conclusions
PSH participation is associated with increases in filling prescription medications overall and improved adherence to antidepressant medications. These results can inform state and federal policy to increase PSH placement among Medicaid enrollees experiencing homelessness.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Walsh CA, Cahir C, Tecklenborg S, Byrne C, Culbertson MA, Bennett KE. The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis. British journal of clinical pharmacology. 2019;85(11):2464-2478.
Ayano G, Tesfaw G, Shumet S. The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis. BMC psychiatry. 2019;19(1):370.
Arnold EM, Strenth CR, Hedrick LP, et al. Medical comorbidities and medication use among homeless adults seeking mental health treatment. Community mental health journal. 2020:1–9.
Hunter CE, Palepu A, Farrell S, Gogosis E, O’Brien K, Hwang SW. Barriers to prescription medication adherence among homeless and vulnerably housed adults in three Canadian cities. Journal of primary care & community health. 2015;6(3):154-161.
Wilder ME, Kulie P, Jensen C, et al. The impact of social determinants of health on medication adherence: a systematic review and meta-analysis. Journal of general internal medicine. 2021;36:1359-1370.
Wilder ME, Zheng Z, Zeger SL, et al. Relationship between social determinants of health and antihypertensive medication adherence in a medicaid cohort. Circulation: Cardiovascular Quality and Outcomes. 2022;15(2):e008150.
National Academies of Sciences, Engineering, Medicine. Permanent supportive housing: evaluating the evidence for improving health outcomes among people experiencing chronic homelessness. National Academies Press; 2018.
Dickson-Gomez J, Quinn K, Bendixen A, et al. Identifying variability in permanent supportive housing: A comparative effectiveness approach to measuring health outcomes. Am J Orthopsychiatry. 2017;87(4):414-424.
The Corporation for Supportive Housing. Summary of state Action: Medicaid & Housing Services. 2022.
DeLia D, Nova J, Chakravarty S, Tiderington E, Kelly T, Cantor JC. Effects of Permanent Supportive Housing on Health Care Utilization and Spending Among New Jersey Medicaid Enrollees Experiencing Homelessness. Medical care. 2021;59:S199-S205.
Hollander MA, Cole ES, Donohue JM, Roberts ET. Changes in Medicaid Utilization and Spending Associated with Homeless Adults’ Entry into Permanent Supportive Housing. Journal of General Internal Medicine. 2021:1–8.
Aubry T, Bloch G, Brcic V, et al. Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: a systematic review. The Lancet Public Health. 2020;5(6):e342-e360.
Bohnhoff JC, Xue L, Hollander MAG, et al. Healthcare Utilization Among Children Receiving Permanent Supportive Housing. Pediatrics. 2023;151(4).
Williams JL, Keaton K, Phillips RW, Crossley AR, Glenn JM, Gleason VL. Changes in Health Care Utilization and Associated Costs After Supportive Housing Placement by an Urban Community Mental Health Center. Community Ment Health J. 2023:1–10.
Lim S, Miller-Archie SA, Singh TP, Wu WY, Walters SC, Gould LH. Supportive housing and its relationship with diabetes diagnosis and management among homeless persons in New York City. American journal of epidemiology. 2019;188(6):1120-1129.
PA Homeless Management Information System. https://pennsylvaniacoc.org/homeless-management-information-system. Accessed.
Czajka JL, Verghese S. Social Security Numbers in Medicaid Records: Reporting and Validity, 2009. Mathematica Policy Research;2013.
Sommers BD, Rosenbaum S. Issues in health reform: how changes in eligibility may move millions back and forth between Medicaid and insurance exchanges. Health affairs. 2011;30(2):228-236.
Centers for Disease Control & Prevention. Calculating proportion of days covered (PDC) for antihypertensive and antidiabetic medications: an evaluation guide for grantees. In:2015.
Wing C, Simon K, Bello-Gomez RA. Designing difference in difference studies: best practices for public health policy research. Annual review of public health. 2018;39.
Marcum ZA, Hanlon JT, Murray MD. Improving medication adherence and health outcomes in older adults: an evidence-based review of randomized controlled trials. Drugs & aging. 2017;34(3):191-201.
MacKinnon L, Kerman N, Socías ME, Brar R, Bardwell G. Primary care embedded within permanent supportive housing for people who use substances: a qualitative study examining healthcare access in Vancouver, Canada. Health & Social Care in the Community. 2022;30(6):e5062-e5073.
Funding
Donald Bourne received funding from the National Institute of General Medical Sciences of the National Institutes of Health (T32GM008208); Clinical and Translational Science Institute, University of Pittsburgh (1 TL1 TR001858); and Evan Cole received funding from the National Institute on Minority Health and Health Disparities grant (R01MD015261). Mara Hollander received funding from the National Institute of Mental Health (T32MH109436-05). Drs. Cole, Donohue, and Xue received funding for related work from an intergovernmental agreement with the Pennsylvania Department of Human Services.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest:
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Bourne, D.S., Xue, L., Hollander, M.A.G. et al. Changes in Medication Utilization and Adherence Associated with Homeless Adults’ Entry into Permanent Supportive Housing. J GEN INTERN MED 39, 1590–1596 (2024). https://doi.org/10.1007/s11606-024-08621-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-024-08621-0