Adherence to Newly Prescribed Diabetes Medications Among Insured Latino and White Patients With Diabetes.

Publisher: American Medical Association Country of Publication: United States NLM ID: 101589534 Publication Model: Print Cited Medium: Internet ISSN: 2168-6114 (Electronic) Linking ISSN: 21686106 NLM ISO Abbreviation: JAMA Intern Med Subsets: MEDLINE

Original Publication: Chicago, IL : American Medical Association, [2013]-

Communication Barriers* ; Diabetes Mellitus, Type 2*/drug therapy ; Diabetes Mellitus, Type 2*/ethnology ; Diabetes Mellitus, Type 2*/psychology ; Medication Adherence*/ethnology ; Medication Adherence*/psychology ; Medication Adherence*/statistics & numerical data ; Physician-Patient Relations*; Culturally Competent Care/*standards ; Prescription Drugs/*therapeutic use; Aged ; Female ; Health Services Accessibility/standards ; Hispanic or Latino ; Humans ; Male ; Middle Aged ; Needs Assessment ; Practice Patterns, Physicians'/statistics & numerical data ; Quality Improvement ; United States/epidemiology ; White People

Importance: Medication adherence is essential to diabetes care. Patient-physician language barriers may affect medication adherence among Latino individuals.
Objective: To determine the association of patient race/ethnicity, preferred language, and physician language concordance with patient adherence to newly prescribed diabetes medications.
Design, Setting, and Participants: This observational study was conducted from January 1, 2006, to December 31, 2012, at a large integrated health care delivery system with professional interpreter services. Insured patients with type 2 diabetes, including English-speaking white, English-speaking Latino, or limited English proficiency (LEP) Latino patients with newly prescribed diabetes medication.
Exposures: Patient race/ethnicity, preferred language, and physician self-reported Spanish-language fluency.
Main Outcomes and Measures: Primary nonadherence (never dispensed), early-stage nonpersistence (dispensed only once), late-stage nonpersistence (received ≥2 dispensings, but discontinued within 24 months), and inadequate overall medication adherence (>20% time without sufficient medication supply during 24 months after initial prescription).
Results: Participants included 21 878 white patients, 5755 English-speaking Latino patients, and 3205 LEP Latino patients with a total of 46 131 prescriptions for new diabetes medications. Among LEP Latino patients, 50.2% (n = 1610) had a primary care physician reporting high Spanish fluency. For oral medications, early adherence varied substantially: 1032 LEP Latino patients (32.2%), 1565 English-speaking Latino patients (27.2%), and 4004 white patients (18.3%) were either primary nonadherent or early nonpersistent. Inadequate overall adherence was observed in 1929 LEP Latino patients (60.2%), 2975 English-speaking Latino patients (51.7%), and 8204 white patients (37.5%). For insulin, early-stage nonpersistence was 42.8% among LEP Latino patients (n = 1372), 34.4% among English-speaking Latino patients (n = 1980), and 28.5% among white patients (n = 6235). After adjustment for patient and physician characteristics, LEP Latino patients were more likely to be nonadherent to oral medications and insulin than English-speaking Latino patients (relative risks from 1.11 [95% CI, 1.06-1.15] to 1.17 [95% CI, 1.02-1.34]; P < .05) or white patients (relative risks from 1.36 [95% CI, 1.31-1.41] to 1.49 [95% CI, 1.32-1.69]; P < .05). English-speaking Latino patients were more likely to be nonadherent compared with white patients (relative risks from 1.23 [95% CI, 1.19-1.27] to 1.30 [95% CI, 1.23-1.39]; P < .05). Patient-physician language concordance was not associated with rates of nonadherence among LEP Latinos (relative risks from 0.92 [95% CI, 0.71-1.19] to 1.04 [95% CI, 0.97-1.1]; P > .28).
Conclusions and Relevance: Nonadherence to newly prescribed diabetes medications is substantially greater among Latino than white patients, even among English-speaking Latino patients. Limited English proficiency Latino patients are more likely to be nonadherent than English-speaking Latino patients independent of the Spanish-language fluency of their physicians. Interventions beyond access to interpreters or patient-physician language concordance will be required to improve medication adherence among Latino patients with diabetes.

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K24 DK102057 United States DK NIDDK NIH HHS; R01 DK090272 United States DK NIDDK NIH HHS

0 (Prescription Drugs)

Date Created: 20170124 Date Completed: 20170623 Latest Revision: 20231112

20240628

PMC5814298

10.1001/jamainternmed.2016.8653

28114642