Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Judith H. Lichtman

Second Advisor

Erica C. Leifheit-Limson

Abstract

Introduction: Prescription drugs can reduce the risk of adverse events post-myocardial infarction (MI), but despite the known benefits, use of these drugs remains low. Prior research has found that younger patients, women, minorities, and those with limited access to care are less likely to be adherent. Currently, little is known on how perceptions of access to care affect adherence rates.

Objective: To determine the association between patients' perceived difficulty accessing care and adherence to prescription drugs 30 days after an MI event in young patients.

Methods: VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients) is a prospective cohort study of young MI patients, 18-55 years of age. Patients' baseline perceived difficulty accessing care and adherence to prescription drugs at 30 days were measured by self-report. Bivariate comparisons of patient characteristics were evaluated using student t-tests and the chi-square test, with statistical significance of p<0.05. The relationship between perceived difficulty accessing care and adherence was tested using multivariate logistic regression that sequentially adjusted for sociodemographic characteristics, medical history, and health insurance status.

Results: Almost half of all patients (45.1%) experienced some difficulty accessing the care that they need. Approximately, 17.4% reported extreme or moderate perceived difficulty and 27.7% reported their perceived difficulty as somewhat or not at all. The three primary reasons patients perceived difficulty were cost, lack of health insurance, and difficulty getting an appointment. In adjusted analyses, patients with extreme or moderate perceived difficulty were 25% less likely to be adherent (OR= 0.75, 95% CI: 0.51-1.13) than those reporting no difficulty, and patients reporting somewhat or little difficulty were 14% less likely to be adherent (OR= 0.86, 95% CI: 0.62-1.19) than those with no perceived difficulty.

Conclusions: Patients' perceptions of difficulty accessing care do not predict 30-day prescription drug adherence after accounting for health insurance status. Healthcare providers should consider the health insurance status of young patients with MI as well as their perceived difficulty accessing care as potential factors that may contribute to one-month medication adherence rates.

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This is an Open Access Thesis.

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