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Medication Adherence, Ethnicity, and the Influence of Multiple Psychosocial and Financial Barriers

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Abstract

Medication adherence is critical for patients with bipolar disorder to avoid symptom exacerbation and diminished quality of life. Most analyses consider adherence barriers individually rather than conjointly, while neglecting potential ethnic differences. 435 patients in the Continuous Improvement for Veterans in Care––Mood Disorders study reported multiple financial and psychosocial factors influencing adherence. Logistic regression modeled adherence as a function of perceived barriers, including cost burden, access, binge drinking, poor therapeutic alliance, and medication beliefs. Nearly half the cohort experienced adherence difficulty, averaging 2.8 barriers, with minority veterans reporting lower adherence than white patients, particularly financial burden and treatment access. Total barriers were significantly associated with worse adherence (OR = 1.24 per barrier), notably poor medication beliefs, binge drinking, and difficulty accessing psychiatric specialists (ORs of 2.41, 1.95 and 1.73, respectively). Veterans with bipolar disorder experience numerous adherence barriers, with certain obstacles proving especially pernicious. Fortunately tailored clinical interventions can improve adherence, particularly by addressing modifiable risk factors.

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Acknowledgments

Funding for this study was provided by the Department of Veterans Affairs, Health Services Research and Development Service (Merit Review IIR 02-283-2, MREP Career Development Award HSR&D 02269).

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Authors and Affiliations

  1. Veterans Affairs HSR&D: South Texas Veterans Health Care System (VERDICT), 7400 Merton Minter Boulevard (VERDICT 11c6), San Antonio, TX, 78229-4404, USA

    John E. Zeber & Laurel A. Copeland

  2. Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    John E. Zeber, Alexander L. Miller & Laurel A. Copeland

  3. VA Ann Arbor Healthcare System, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, USA

    John F. McCarthy, Kara Zivin, Marcia Valenstein & Amy M. Kilbourne

  4. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA

    John F. McCarthy, Kara Zivin, Marcia Valenstein & Amy M. Kilbourne

  5. Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Devra Greenwald

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  1. John E. Zeber
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  2. Alexander L. Miller
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Correspondence to John E. Zeber.

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Zeber, J.E., Miller, A.L., Copeland, L.A. et al. Medication Adherence, Ethnicity, and the Influence of Multiple Psychosocial and Financial Barriers. Adm Policy Ment Health 38, 86–95 (2011). https://doi.org/10.1007/s10488-010-0304-1

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