Alicia Fernández|Judy Quan|Howard H. Moffet|Melissa M. Parker|Dean Schillinger|Andrew J. Karter
Adherence to Newly Prescribed Diabetes Medications Among Insured Latino and White Patients With Diabetes
San Francisco General Hospital|University of California, San Francisco|San Francisco General Hospital|University of California, San Francisco|Kaiser Permanente|Kaiser Permanente|San Francisco General Hospital|University of California, San Francisco|Kaiser Permanente
h3importanceh3 medication adherence essential diabetes care patientphysician language barriers may affect medication adherence among latino individuals h3objectiveh3 determine association patient raceethnicity preferred language physician language concordance patient adherence newly prescribed diabetes medications h3design setting participantsh3 observational study conducted january 1 2006 december 31 2012 large integrated health care delivery system professional interpreter services insured patients type 2 diabetes including englishspeaking white englishspeaking latino limited english proficiency lep latino patients newly prescribed diabetes medication h3exposuresh3 patient raceethnicity preferred language physician selfreported spanishlanguage fluency h3main outcomes measuresh3 primary nonadherence never dispensed earlystage nonpersistence dispensed latestage nonpersistence received 2 dispensings discontinued within 24 months inadequate overall medication adherence gt20 time without sufficient medication supply 24 months initial prescription h3resultsh3 participants included 21 878 white patients 5755 englishspeaking latino patients 3205 lep latino patients total 46 131 prescriptions new diabetes medications among lep latino patients 502 n 1610 primary care physician reporting high spanish fluency oral medications early adherence varied substantially 1032 lep latino patients 322 1565 englishspeaking latino patients 272 4004 white patients 183 either primary nonadherent early nonpersistent inadequate overall adherence observed 1929 lep latino patients 602 2975 englishspeaking latino patients 517 8204 white patients 375 insulin earlystage nonpersistence 428 among lep latino patients n 1372 344 among englishspeaking latino patients n 1980 285 among white patients n 6235 adjustment patient physician characteristics lep latino patients likely nonadherent oral medications insulin englishspeaking latino patients relative risks 111 95 ci 106115 117 95 ci 102134ipi lt 05 white patients relative risks 136 95 ci 131141 149 95 ci 132169ipi lt 05 englishspeaking latino patients likely nonadherent compared white patients relative risks 123 95 ci 119127 130 95 ci 123139ipi lt 05 patientphysician language concordance associated rates nonadherence among lep latinos relative risks 092 95 ci 071119 104 95 ci 09711ipi gt 28 h3conclusions relevanceh3 nonadherence newly prescribed diabetes medications substantially greater among latino white patients even among englishspeaking latino patients limited english proficiency latino patients likely nonadherent englishspeaking latino patients independent spanishlanguage fluency physicians interventions beyond access interpreters patientphysician language concordance required improve medication adherence among latino patients diabetes