***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Despite the rollout of Medicare Part D , cost-related nonadherence ( CRN ) among older adults remains a problem . Objectives : To examine the rate and correlates of self-reported CRN among a population of older persons with diabetes . Research Design : Cross-sectional . Subjects : A total of 1264 Part D patients with diabetes , who entered the coverage gap in 2006 . Measures : Initial administrative medication lists were verified in computer-assisted telephone interviews , in which participants brought their medication bottles to the phone . Medications were classified into cardiometabolic ( diabetes , hypertension , cholesterol-lowering ) , symptom relief , and “ other . ” Participants were asked if they had any CRN during 2006 , and if so to which medication/s . We used the person-medication dyad as the unit of analysis , and tested a multivariate r and om effects logistic regression model to analyze the correlates of CRN . Results : Approximately 16 % of participants reported CRN . CRN was more frequent for cholesterol-lowering medications ( relative risk , 1.54 ; 95 % confidence interval , 1.01–2.32 ) compared with medications taken for symptom relief . CRN was reported less frequently with increasing age above 75 years , compared with patients between 65 and 69 . In addition , compared with those with incomes of ≥$40,000 , CRN risk for those with incomes of < $ 25,000 was markedly higher ( relative risk , 3.05 ; 95 % confidence interval , 1.99–4.65 ) . Conclusions : In summary , we found high rates of CRN among Medicare beneficiaries with diabetes , particularly those with lower incomes . We observed more frequent CRN for cholesterol-lowering medications as compared with medications for symptom relief . Efforts to ensure medication affordability for this population will be important in boosting adherence to key medications OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Background : High out-of-pocket expenditures for prescription medications could lead people with chronic illnesses to restrict their use of these medications . Whether adults experience adverse health outcomes after having restricted medication use because of cost is not known . Methods : We analyzed data from 2 prospect i ve cohort studies of adults who reported regularly taking prescription medications using 2 waves of the Health and Retirement Study ( HRS ) , a national survey of adults aged 51 to 61 in 1992 , and the Asset and Health Dynamics Among the Oldest Old ( AHEAD ) Study , a national survey of adults aged 70 or older in 1993 ( n = 7991 ) . We used multivariable logistic and Poisson regression models to assess the independent effect on health outcomes over 2 to 3 years of follow up of reporting in 1995–1996 having taken less medicine than prescribed because of cost during the prior 2 years . After adjusting for differences in sociodemographic characteristics , health status , smoking , alcohol consumption , body mass index ( BMI ) , and comorbid chronic conditions , we determined the risk of a significant decline in overall health among respondents in good to excellent health at baseline and of developing new disease-related adverse outcomes among respondents with cardiovascular disease , diabetes , arthritis , and depression . Results : In adjusted analyses , 32.1 % of those who had restricted medications because of cost reported a significant decline in their health status compared with 21.2 % of those who had not ( adjusted odds ratio [ AOR ] , 1.76 ; confidence interval [ CI ] , 1.27–2.44 ) . Respondents with cardiovascular disease who restricted medications reported higher rates of angina ( 11.9 % vs. 8.2 % ; AOR , 1.50 ; CI , 1.09–2.07 ) and experienced higher rates of nonfatal heart attacks or strokes ( 7.8 % vs. 5.3 % ; AOR , 1.51 ; CI , 1.02–2.25 ) . After adjusting for potential confounders , we found no differences in disease-specific complications among respondents with arthritis and diabetes , and increased rates of depression only among the older cohort . Conclusions : Cost-related medication restriction among middle-aged and elderly Americans is associated with an increased risk of a subsequent decline in their self-reported health status , and among those with preexisting cardiovascular disease with higher rates of angina and nonfatal heart attacks or strokes . Such cost-related medication restriction could be a mechanism for worse health outcomes among low-income and other vulnerable population s who lack adequate insurance coverage AIMS Cost burdens represent a significant barrier to medication adherence among chronically ill patients , yet financial pressures may be mitigated by clinical or organizational factors , such as treatment aligned with the Chronic Care Model ( CCM ) . This study examines how perceptions of chronic illness care attenuate the relationship between adherence and cost burden . METHODS Surveys were administered to patients at 40 small community-based primary care practice s. Medication adherence was assessed using the 4-item Morisky scale , while five cost-related items documented recent pharmacy restrictions . CCM experiences were assessed via the 20-item Patient Assessment of Chronic Illness Care ( PACIC ) . Nested r and om effects models determined if chronic care perceptions modified the association between medication adherence and cost-related burden . RESULTS Of 1823 respondents reporting diabetes and other chronic diseases , one-quarter endorsed intrapersonal adherence barriers , while 23 % restricted medication due of cost . Controlling for age and health status , the relationship between medication cost and CCM with adherence was significant ; including PACIC scores attenuated cost-related problems patients with adequate or problematic adherence behavior . CONCLUSIONS Patients experiencing treatment more consistent with the CCM reported better adherence and lower cost-related burden . Fostering highly activated patients and shared clinical decision making may help alleviate medication cost pressures and improve adherence 
    Output:
    
The studies that evaluated patients with fully subsidized payment scheme found that the medication adherence was poor among patients with nonsevere illness .
Conclusion Although medication adherence was improved with the reduction of cost-sharing such as lower copayment , higher drug coverage , and prescription cap , patients with full-medication subsidies payment scheme ( received medication at no cost ) were also found to have poor adherence to their medication .