Gangavelli Apoorva, Liu Zihao, Wang Jeffrey, Okoh Alexis, Steinberg Rebecca S, Patel Krishan, Patel Shivani A, Dickert Neal W, Morris Alanna A
Emory University School of Medicine, Division of Cardiology, Atlanta, GA.
Emory Rollins School of Public Health, Department of Epidemiology, Atlanta, GA.
J Card Fail. 2024 Jul;30(7):947-951. doi: 10.1016/j.cardfail.2024.02.016. Epub 2024 Mar 6.
Patients residing in socioeconomically deprived neighborhoods experience higher hospital readmission rates after hospitalization for heart failure (HF). The role of medication access in the excessive readmissions in this group is poorly understood. This study explored patients' perspectives on medication access by individuals living in socioeconomically deprived neighborhoods who had experienced HF readmission.
We conducted semistructured in-depth interviews with 25 patients (mean age 61 ± 9 years, 96% Black, 40% women) who were readmitted with acute HF at Emory Healthcare hospitals and were living in highly deprived neighborhoods (top decile of the Social Deprivation Index). Qualitative descriptive analyses of the interviews were performed by using a multilevel coding strategy.
Most patients (84%) highlighted medications as a driver of HF readmission. Patients' reported reasons for lack of medication access included medication costs (60%), having access to refills only through an emergency department or hospitalization (36%), limited access to transportation (12%), and limited understanding of medications' role in disease management (12%).
Lack of access to medications for patients with HF who live in socioeconomically distressed neighborhoods exacerbate excess hospitalizations in this vulnerable population. This study focuses on patients' perspectives and experiences and identifies some potentially high-value areas to focus on in trying to enhance access and adherence to evidence-based therapies.
居住在社会经济贫困社区的患者因心力衰竭（HF）住院后的医院再入院率较高。药物获取在该群体过度再入院中的作用尚不清楚。本研究探讨了经历过HF再入院的、居住在社会经济贫困社区的患者对药物获取的看法。
我们对25名患者（平均年龄61±9岁，96%为黑人，40%为女性）进行了半结构化深入访谈，这些患者在埃默里医疗保健医院因急性HF再次入院，且居住在高度贫困社区（社会剥夺指数最高的十分位数）。采用多层次编码策略对访谈进行定性描述分析。
大多数患者（84%）强调药物是HF再入院的一个驱动因素。患者报告的药物获取不足的原因包括药物成本（60%）、仅通过急诊科或住院才能获得续方（36%）、交通不便（12%）以及对药物在疾病管理中的作用了解有限（12%）。
社会经济困境社区中HF患者无法获得药物加剧了这一弱势群体的过度住院情况。本研究关注患者的观点和经历，并确定了一些在试图改善循证治疗的获取和依从性方面可能具有高价值的关注领域。
