@article{TEXTUAL,
      recid = {7727},
      author = {Zhang, James X. and Meltzer, David O.},
      title = {Prevalence and persistence of cost-related medication  non-adherence before and during the COVID-19 pandemic among  medicare patients at high risk of hospitalization},
      journal = {PLOS ONE},
      address = {2023-08-29},
      number = {TEXTUAL},
      abstract = {&lt;p&gt;Objective: To study cost-related medication  non-adherence (CRN) for a 30-month period before and during  the COVID-19 pandemic using a sample of Medicare patients  at high risk of hospitalization.&lt;/p&gt; &lt;p&gt;Design: A novel  data set of quarterly surveys of CRN was used to evaluate  CRN before and during the COVID-19 pandemic. Generalized  Estimating Equation (GEE) analyses were conducted to  evaluate the adjusted coefficients of change in CRN  behaviors controlling for socio-demographic and health  characteristics.&lt;/p&gt; &lt;p&gt;Participants: Six hundred  seventy-seven Medicare beneficiaries at high risk of  hospitalization who were alive on January 1, 2020 and  followed up through quarterly surveys on CRN for 30 months  before and during the COVID-19 pandemic.&lt;/p&gt; &lt;p&gt;Main  outcomes and measures: Two metrics of prevalence and  persistence of CRN and their adjusted coefficients in GEE  with binomial family distribution and log link function  controlling for socio-demographic and health  characteristics.&lt;/p&gt; &lt;p&gt;Results: A total of 5,990 quarterly  surveys were completed by the 677 patients during the  30-month study period. Among the 677 patients, 250 (37%)  were men, 591 (87%) were African American, and 288 (42%)  were Medicare-Medicaid dual eligible. The unadjusted  prevalence of CRN before and during the COVID-19 pandemic  was 31.1% and 25.7% respectively (p = 0.02 by Chi-squared  test), and persistent CRN rates were 12.1% and 9.7%  respectively (p = 0.17 by Chi-squared test). The adjusted  odds ratio of CRN prevalence during the pandemic compared  to the pre-pandemic level was 0.75 (p&lt;0.01), and 0.74 (p =  0.03) for persistent CRN in GEE estimations.&lt;/p&gt;  &lt;p&gt;Conclusion and relevance: There are coherent evidence of  a reversal of CRN rates during the COVID-19 pandemic among  this high-need, high-cost resource utilization Medicare  population. Patients’ CRN behaviors may be responsive to  exogenous impacts, and the behaviors changed in the same  direction with similar magnitude in terms of prevalence  (the extensive margin) and persistence (the intensive  margin). More research is needed to advance the  understanding of the driving forces behind patients’  behavioral changes and to identify factors that may be  informative for reducing CRN in the long run.&lt;/p&gt;},
      url = {http://knowledge.uchicago.edu/record/7727},
}