Yang Geoffrey, Chan Jesse, Choi Michael, Singh Karanbir, Slocum Giles W, Calixte Rose, Gore Robert, Gottlieb Michael
Rush University Medical College, 600 S. Paulina, Suite 571, Chicago, IL 60612, United States of America.
SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America.
Am J Emerg Med. 2025 Sep;95:16-27. doi: 10.1016/j.ajem.2025.05.009. Epub 2025 May 13.
Social determinants of health (SDoH), including factors like income, education, and housing, can influence health outcomes and medication adherence, especially among emergency department (ED) patients. This study explores the relationship between SDoH and medication adherence among patients in urban EDs.
We conducted a cross-sectional survey across three geographically diverse urban EDs from May 2022 to February 2024 among ED patients aged ≥18 who were taking ≥4 prescription medications or ≥ 1 "high-risk" medication, including immunosuppressants, antiepileptics, sedatives, anti-Parkinson agents, antithrombotics, antihyperglycemics, or cardiovascular medications. The AAFP Social Needs Screening Tool and a validated medication adherence questionnaire were used. Data were analyzed using univariate and multivariable logistic regression to identify associations between SDoH and medication adherence.
345 participants completed the survey. Among survey respondents, 28 % delayed medical visits due to transportation issues, while 31.9 % faced financial difficulties. Housing instability was reported by 16.3 % of participants. Regarding medication adherence, 42.4 % of patients forgot to take their medications, 23.7 % skipped doses, and 34.8 % missed appointments. Multivariate analysis revealed that younger patients (<65 years) were more likely to experience running out of medications. Financial instability and transportation difficulties were also associated with poor adherence to prescribed medications and increased difficulty with healthcare utilization tasks.
This study highlights the associations of SDoH with medication adherence in urban ED settings. Transportation, financial, and housing challenges were associated with greater odds of exhibiting poor medication adherence. Younger patients also demonstrated higher rates of non-adherence. Addressing these SDoH through targeted interventions could improve medication adherence and overall health outcomes.
健康的社会决定因素（SDoH），包括收入、教育和住房等因素，会影响健康结果和药物依从性，尤其是在急诊科（ED）患者中。本研究探讨了城市急诊科患者中SDoH与药物依从性之间的关系。
2022年5月至2024年2月，我们在三个地理位置不同的城市急诊科对年龄≥18岁、正在服用≥4种处方药或≥1种“高风险”药物（包括免疫抑制剂、抗癫痫药、镇静剂、抗帕金森药、抗血栓药、抗高血糖药或心血管药物）的急诊科患者进行了横断面调查。使用了美国家庭医师学会社会需求筛查工具和一份经过验证的药物依从性问卷。采用单变量和多变量逻辑回归分析数据，以确定SDoH与药物依从性之间的关联。
345名参与者完成了调查。在调查对象中，28%的人因交通问题推迟就医，31.9%的人面临经济困难。16.3%的参与者报告住房不稳定。在药物依从性方面，42.4%的患者忘记服药，23.7%的患者漏服剂量，34.8%的患者错过预约。多变量分析显示，年轻患者（<65岁）更有可能出现药物短缺。经济不稳定和交通困难也与处方药物依从性差以及医疗保健利用任务难度增加有关。
本研究强调了城市急诊科环境中SDoH与药物依从性之间的关联。交通、经济和住房挑战与药物依从性差的几率更高有关。年轻患者的不依从率也更高。通过有针对性的干预措施解决这些SDoH问题，可以提高药物依从性和整体健康结果。
