Full subsidy and direct delivery of essential chronic disease medications for low-income populations: A pilot randomized controlled trial.

INTRODUCTION

Care transition interventions focused on medication therapy management have not proven effective among low-income populations. This pilot study assesses a novel intervention approach that directly addresses social determinants of health (SDoH) reported as major barriers to medication adherence post-hospitalization by low-income patients.

METHODS

This pilot pragmatic randomized controlled trial enrolled hospitalized adult Medicaid and uninsured patients with ambulatory care sensitive conditions using ≥2 chronic disease medications from a large safety-net hospital in the Mid-South. Patients were randomized to one of four groups 1) usual care, 2) full medication subsidy, 3) bedside delivery at discharge and subsequent home delivery of medications, or 4) full medication subsidy combined with bedside delivery and home delivery of medications. Interventions were implemented through standardized hospital pharmacy protocols for 3 months following index hospital discharge. Using generalized linear models, we assessed average adherence to chronic disease medications using pill counts and quality of life using a patient-reported Behavioral Risk Factor Surveillance System Health-Related Quality of Life survey at 3-month.

RESULTS

Of 42 patients randomized, the majority were uninsured (52 %), men (60 %), and African Americans (81 %). The mean was 51.1 (SD±10.5) years. The majority had less than a high school education (80.9 %) and low health literacy (51.3 %). At baseline, 40.4 % reported not being able to pay rent and utility bills, 28.6 % reported living in an unsafe neighborhood, and 45.2 % reported having food insecurity in the past year. Those randomized to full medication subsidy, bedside delivery, and home delivery (Group 4) had the highest nominal mean medication adherence at 3-months at 87.5 % (p = 0.20) when compared to the other three groups (group 1: 69.5 %, group 2: 64.2 %, group 3: 59.3 %). Additionally, after adjusting for baseline quality of life, at 3-month, patients in group 4 reported the lowest nominal mean number of days in the past 30 days when their physical health was not good, compared to other groups (group 1: 15.5, group 2: 11.1, group 3: 10.3, group 4: 7.8, p = 0.25).

CONCLUSIONS

While not statistically significant, the findings demonstrate the potential benefit of providing both medication subsidy and bedside and home delivery of medications among low-income populations.