Assessment of cost-related medication nonadherence during routine hospital-based care: Association with racial disparities and hospital utilization

Purpose Cost-related medication nonadherence (CRNA) is a prevalent public health problem tied to social determinants of health. The purpose of this study was to describe a method to collect CRNA and the association this has with hospital utilization, as well as potential racial disparities in the prevalence of CRNA. Methods We conducted a pilot prospective observational study by embedding 2 validated survey questions aimed at capturing CRNA into the admission process in an academic 10-hospital system. We evaluated process adherence and the association between CRNA and patient demographics, outcomes, and overall hospital utilization. Results During the study period, 7,831 patients were admitted, of whom 2,878 were screened for CRNA. Of those screened, 144 (5.0%) reported experiencing CRNA in the last year and 99 (3.4%) reported experiencing CRNA in the last 3 months. Patients with CRNA were younger, more likely to be male and nonwhite, and had higher rates of chronic comorbidities. Patients who reported experiencing CRNA in the last 3 months had a longer initial length of stay, but only 5% had an ambulatory pharmacy follow-up visit. Overall process adherence was higher for white patients, largely due to hospital-level effects. Conclusion Embedding assessment for CRNA into routine care captures a medically complex and socially vulnerable population. Assessment of CRNA represents a critical first step in addressing an important social determinant of health and represents an opportunity to standardize care to reduce cost, as well as improve equity and patient outcomes.