Attitudes, Beliefs, and Cost-Related Medication Nonadherence Among Adults Aged 65 or Older With Chronic Diseases

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The tested model hypothesized that 1) the distal factor age would affect CRN through intermediate (poor physical access to health care) and proximal (medication unaffordability and patient satisfaction with health care services) factors; 2) the distal factors financial resource availability and serious mental illness would directly and indirectly affect CRN through intermediate (poor physical access to health care) and proximal factors (medication unaffordability and patient satisfaction with health care services); 3) the intermediate factor (poor physical access to health care) would affect CRN indirectly through proximal factors (medication unaffordability and patient satisfaction with health care services); 4) the proximal factor (medication unaffordability) would affect CRN directly and indirectly through patient satisfaction with health care services; and 5) the proximal factor (patient satisfaction with health care services) would affect CRN directly.

Figure 1.
Hypothesized model depicting factors influencing cost-related medication nonadherence (CRN) among adults aged 65 years or older, National Health Interview Survey, 2015. The final hypothesized model included 3 exogenous variables (aged 75 or older, serious mental illness, and financial resource availability) and 4 endogenous variables (CRN, patient satisfaction with health care services, poor physical access to health care, and medication unaffordability). Arrow indicates “effects on”; for example, effects of poor physical access to health care on medication unaffordability.

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A greater likelihood of CRN was associated with greater medication unaffordability (β = 0.55), lower levels of patient satisfaction with health care (β = −0.06), less financial resource availability (β = −0.07), and serious mental illness (β = 0.04). Medication unaffordability was associated with poor physical access to health care (β = 0.13), lower levels of financial resource availability (β = −0.12), serious mental illness (β = 0.11), and being younger than 75 (β = −0.07). Lower levels of patient satisfaction with health care services were associated with greater medication unaffordability (β = −0.10), poorer physical access to health care (β = −0.14), and less financial resource availability (β = 0.11). Poor physical access to health care was negatively associated with financial resource availability (β = −0.13). Effect of age on poor physical access to health care was not significant (β = 0.003).

Figure 2.
Path diagram of the final structural equation modeling among adults aged 65 years or older, National Health Interview Survey, 2015. The path diagram describes the magnitudes and significance of the hypothesized relationship between age, serious mental illness, financial resource availability, patient’s attitudes and beliefs, and cost-related medication nonadherence (CRN). Arrow indicates “effects on”; for example, effects of poor physical access to health care on medication unaffordability.

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