Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Zeber, J.E., A.L. Miller, L.A. Copeland, J.F. McCarthy, Kara Zivin, M. Valenstein, D. Greenwald, and A. Kilbourne. 2011. "Medication Adherence, Ethnicity, and the Influence of Multiple Psychosocial and Financial Barriers." Administration and Policy in Mental Health and Mental Health Services Research, 38(2): 86-95.
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.
Country of focus: United States.