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Racial Disparities in the Quality of Medication Use in Older Adults: Baseline Findings from a Longitudinal Study

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Abstract

BACKGROUND

Medication-related problems are prevalent in older adults and adversely affect the quality of care. It has been suggested that racial differences exist in medication use. Most efforts to evaluate the quality of medication use target specific drugs or disease states, or a set of pre-defined quality indicators, rather than the patient.

OBJECTIVE

We conducted a prospective cohort study to determine the prevalence and types of medication-related problems in older adults, examining the impact of race on quality medication use.

METHODS

In-home interviews and medical record reviews of 200 (100 white, 100 black) older adults were conducted three times over 1 year. The quality of medication use was measured using a clinical pharmacist’s assessment of quality and the Assessing Care of Vulnerable Elders quality indicators. We used logistic and negative binomial regression models to analyze the two primary endpoints of prevalence and number of medication-related problems.

RESULTS

Mean age was 78.3 (whites) and 75.5 (blacks), with the majority being female. Although whites used more medications than blacks (11.6 versus 9.7; p < 0.01), blacks had more medication-related problems per person than whites (6.2 versus 4.9; p < 0.01). All patients had at least one medication-related problem; undertreatment, suboptimal drug, suboptimal dosing, and nonadherence were most prevalent. Blacks had significantly higher rates of nonadherence than whites (68% versus 42%; p < 0.01).

CONCLUSION

Medication-related problems are prevalent in community-residing older adults. Blacks had more medication-related problems than whites, including higher rates of nonadherence. These findings require further study to better understand racial disparities in quality medication use.

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Acknowledgment

Dr. Roth had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

The authors wish to thank Robin H. Zook (RHZ), PharmD, CGP, MTM Pharmacy Associates, for her assistance in subject recruitment, enrollment, and data collection.

The authors wish to thank Ryan Owenby, PharmD, for his assistance in project management and data entry (Ryan was a Doctor of Pharmacy student and a student research assistant, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, when this study was ongoing).

The authors wish to thank John Paul Timmins, MBA, Planning Systems Productivity & Co., for designing, developing, and maintaining the study database.

Funding Sources

Drs. Roth and Ivey receive funding from the National Institutes of Health, National Institute on Aging (Principal Investigator (MTR): Research and Career Development Award). The funding agency has no role in the design and conduct of the study, data collection, management, analysis, interpretation of the data, or preparation, review, or approval of this manuscript.

Drs. Esserman and Weinberger receive funding from the National Institutes of Health (CTSA UL1RR025747). The funding agency has no role in the design and conduct of the study, data collection, management, analysis, interpretation of the data, or preparation, review, or approval of this manuscript.

The study was also supported by an American College of Clinical Pharmacy (ACCP) Frontiers Fund Research and Career Development Award.

Conflict of Interest

There are no conflicts of interest or financial interests to declare for any of the four authors.

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Authors and Affiliations

  1. Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Campus Box 7360, Kerr Hall, Chapel Hill, NC, 27599-7360, USA

    Mary T. Roth PharmD, MHS

  2. Division of General Medicine and Clinical Epidemiology, School of Medicine and Department of Biostatistics, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Denise A. Esserman PhD

  3. Division of Pharmacy Practice and Experiential Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Jena L. Ivey PharmD

  4. Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina and Senior Career Scientist, Durham VAMC Center for Health Services Research, Durham, NC, USA

    Morris Weinberger PhD

Authors
  1. Mary T. Roth PharmD, MHS
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  2. Denise A. Esserman PhD
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  3. Jena L. Ivey PharmD
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  4. Morris Weinberger PhD
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Corresponding author

Correspondence to Mary T. Roth PharmD, MHS.

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Roth, M.T., Esserman, D.A., Ivey, J.L. et al. Racial Disparities in the Quality of Medication Use in Older Adults: Baseline Findings from a Longitudinal Study. J GEN INTERN MED 25, 228–234 (2010). https://doi.org/10.1007/s11606-009-1180-9

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  • DOI: https://doi.org/10.1007/s11606-009-1180-9

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