Federman Alex D, Safran Dana Gelb, Keyhani Salomeh, Cole Helen, Halm Ethan A, Siu Albert L
Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York, USA.
Am J Geriatr Pharmacother. 2009 Apr;7(2):117-29. doi: 10.1016/j.amjopharm.2009.04.003.
Lack of awareness may be a significant barrier to participation by low- and middle-income seniors in pharmaceutical cost-assistance programs.
The goal of this study was to determine whether older adults' awareness of 2 major state and federal pharmaceutical cost-assistance programs was associated with the seniors' ability to access and process information about assistance programs.
Data were gathered from a cross-sectional study of independently living, English- or Spanish-speaking adults aged > or =60 years. Participants were interviewed in 30 community-based settings (19 apartment complexes and 11 senior centers) in New York, New York. The analysis focused on adults aged > or =65 years who lacked Medicaid coverage. Multivariable logistic regression was used to model program awareness as a function of information access (family/social support, attendance at senior or community centers and places of worship, viewing of live health insurance presentations, instrumental activities of daily living, site of medical care, computer use, and having a proxy decision maker for health insurance matters) and information-processing ability (education level, English proficiency, health literacy, and cognitive function). The main outcome measure was awareness of New York's state pharmaceutical assistance program (Elderly Pharmaceutical Insurance Coverage [EPIC]]) and the federal Medicare Part D low-income subsidy program (Extra Help).
A total of 269 patients were enrolled (mean [SD] age, 76.9 [7.5] years; 32.0% male; 39.9% white). Awareness of the programs differed widely: 77.3%) knew of EPIC! and 22.3% knew of Extra Help. In multivariable analysis, study participants were more likely to have heard of the EPIC program if they had attended a live presentation about health insurance issues (adjusted odds ratio [AOR], 3.40; 95% CI, 1.20-9.61) and less likely if they received care in a clinic (AOR, 0.45; 95% CI, 0.23-0.92). Awareness of Extra Help in the multivariable models was more likely among study participants who had viewed a live health insurance presentation (AOR, 3.35; 95% CI, 1.55-7.24) and less likely for those with inadequate health literacy (AOR, 0.15; 95% CI, 0.03-0.74).
Viewing of live health insurance presentations and adequate health literacy were associated with greater awareness of important pharmaceutical cost-assistance programs in this study in low-income, elderly individuals. The findings suggest that use of live presentations, in addition to health literacy materials and messages, may be important strategies in promoting knowledge of and enrollment in state and federal pharmaceutical cost-assistance programs for low-income seniors.
意识淡薄可能是低收入和中等收入老年人参与药品费用援助计划的重大障碍。
本研究的目的是确定老年人对两项主要的州和联邦药品费用援助计划的知晓情况是否与老年人获取和处理援助计划信息的能力相关。
数据来自一项对年龄≥60岁、独立生活、说英语或西班牙语的成年人的横断面研究。在纽约市的30个社区场所（19个公寓小区和11个老年中心）对参与者进行了访谈。分析聚焦于年龄≥65岁且未参加医疗补助的成年人。多变量逻辑回归用于将计划知晓情况建模为信息获取（家庭/社会支持、参加老年或社区中心及宗教场所活动、观看现场健康保险演示、日常生活工具性活动、医疗护理地点、使用电脑以及有健康保险事务的代理决策者）和信息处理能力（教育水平、英语熟练程度、健康素养和认知功能）的函数。主要结局指标是对纽约州药品援助计划（老年药品保险覆盖计划[EPIC]）和联邦医疗保险D部分低收入补贴计划（额外帮助）的知晓情况。
共纳入269例患者（平均[标准差]年龄为76.9[7.5]岁；男性占32.0%；白人占39.9%）。对这些计划的知晓情况差异很大：77.3%的人知道EPIC！22.3%的人知道额外帮助。在多变量分析中，研究参与者如果参加过关于健康保险问题的现场演示，就更有可能听说过EPIC计划（调整后的优势比[AOR]为3.40；95%置信区间为1.20 - 9.61），而如果在诊所接受治疗则可能性较小（AOR为0.45；95%置信区间为0.23 - 0.92）。在多变量模型中，看过现场健康保险演示的研究参与者更有可能知晓额外帮助（AOR为3.35；95%置信区间为1.55 - 7.24），而健康素养不足的参与者知晓的可能性较小（AOR为0.15；95%置信区间为0.03 - 0.74）。
在本研究的低收入老年人中，观看现场健康保险演示和具备足够的健康素养与对重要药品费用援助计划的更高知晓度相关。研究结果表明，除了健康素养材料和信息外，使用现场演示可能是促进低收入老年人了解并参与州和联邦药品费用援助计划的重要策略。
