{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:31:37Z","timestamp":1789684297351,"version":"4.0.1"},"reference-count":19,"publisher":"CSIRO Publishing","issue":"2","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":2278,"URL":"https:\/\/doi.org\/10.1071\/journalslicense"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Medication adherence is a significant public health concern. Australian studies of statins show patients facing the highest copayments are the least likely to be adherent. This study examined whether the association identified between adherence and costs for statins also applies to a wider group of medications prescribed for Australian patients with chronic conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from 267 086 participants in the Sax Institute\u2019s 45 and Up Study linked to data from the Pharmaceutical Benefits Scheme (PBS) provided by the Department of Human Services were used. Patients using angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, glitazones and bisphosphonates were identified and classified according to concessional status and whether they had access to the PBS \u2018safety net\u2019. Data were analysed using mainly descriptive methods to investigate the association of adherence with cost and other selected covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across medications, the group facing the highest copayment was least adherent. Speaking a language other than English at home and facing high levels of psychological distress were also associated with lower levels of adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>As for statins, the main financial determinant of adherence is cost in the form of prescribed copayments, suggesting that this may apply across many medications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>What is known about the topic?<\/jats:title>\n                    <jats:p>Previous studies have shown patients\u2019 concern about the costs of pharmaceuticals, and more detailed studies of statins show that the lowest adherence relates to patients facing the highest copayments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>What does this paper add?<\/jats:title>\n                    <jats:p>This paper provides support for the contention that the results found for statins broadly apply across more medications used by people with chronic conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>What are the implications for practitioners?<\/jats:title>\n                    <jats:p>Although practitioners cannot affect legislated copayments, they can consider the costs of options for medications for patients with chronic conditions, especially those general patients who have not reached the safety net, and they can be aware that patients from homes where English is not spoken and patients with high levels of psychological distress are also likely to have low adherence without intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/ah18146","type":"journal-article","created":{"date-parts":[[2019,3,3]],"date-time":"2019-03-03T21:16:40Z","timestamp":1551647800000},"page":"270-276","source":"Crossref","is-referenced-by-count":1,"title":["Failure to access prescribed pharmaceuticals by older patients with chronic conditions"],"prefix":"10.1071","volume":"44","author":[{"given":"Ian","family":"McRae","sequence":"first","affiliation":[{"name":"ACentre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Florey, Building 54, Mills Road, Canberra, ACT 0200, Australia."},{"name":"DCorresponding author. Email: ian.s.mcrae@anu.edu.au"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kees","family":"van Gool","sequence":"additional","affiliation":[{"name":"BCentre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Building 5 Block D, 1\u201359 Quay Street, Haymarket, NSW 2000, Australia. Email: kees.vangool@uts.edu.au"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Hall","sequence":"additional","affiliation":[{"name":"BCentre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Building 5 Block D, 1\u201359 Quay Street, Haymarket, NSW 2000, Australia. Email: kees.vangool@uts.edu.au"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurann","family":"Yen","sequence":"additional","affiliation":[{"name":"CDepartment of Health Services Research and Policy Research, School of Population Health, The Australian National University, 62A Mills Road, Canberra, ACT 0200, Australia. Email: laurann.yen@anu.edu.au"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Wright","sequence":"additional","affiliation":[{"name":"BCentre for Health Economics Research and Evaluation, University of Technology Sydney, Level 2, Building 5 Block D, 1\u201359 Quay Street, Haymarket, NSW 2000, Australia. Email: kees.vangool@uts.edu.au"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"67","published-online":{"date-parts":[[2019,3,4]]},"reference":[{"key":"2025121500495269300_R1","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1111\/j.1365-2125.2012.04167.x","article-title":"A new taxonomy for describing and defining adherence to medications.","volume":"73","author":"Vrijens","year":"2012","journal-title":"Br J Clin Pharmacol"},{"key":"2025121500495269300_R2","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1111\/1475-6773.12547","article-title":"Medication nonadherence: the role of cost, community, and individual factors.","volume":"52","author":"Abbass","year":"2017","journal-title":"Health Serv Res"},{"key":"2025121500495269300_R3","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3389\/fphar.2013.00091","article-title":"Determinants of patient adherence: a review of systematic reviews.","volume":"4","author":"Kardas","year":"2013","journal-title":"Front Pharmacol"},{"key":"2025121500495269300_R4","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1007\/s11606-007-0180-x","article-title":"Patients at-risk for cost-related medication nonadherence: a review of the literature.","volume":"22","author":"Briesacher","year":"2007","journal-title":"J Gen Intern Med"},{"key":"2025121500495269300_R5","doi-asserted-by":"publisher","first-page":"2323","DOI":"10.1377\/hlthaff.2010.0862","article-title":"How health insurance design affects access to care and costs, by income, in eleven countries.","volume":"29","author":"Schoen","year":"2010","journal-title":"Health Aff (Millwood)"},{"key":"2025121500495269300_R6","unstructured":"Menzies Centre for Health Policy. Survey of attitudes towards the Australian health system \u2013 part 2: financial stress and the Australian health system. 2008. Available at: https:\/\/ses.library.usyd.edu.au\/\/bitstream\/2123\/19909\/2\/2008surveyfinancialsummary.pdf [verified 3 February 2019]."},{"key":"2025121500495269300_R7","unstructured":"Australian Bureau of Statistics (ABS). 4839.0 \u2013 Patient experiences in Australia: summary of findings, 2015\u201316. 2016. Available at: http:\/\/www.abs.gov.au\/AUSSTATS\/abs@.nsf\/DetailsPage\/4839.02015-16?OpenDocument [verified 18 December 2016]."},{"key":"2025121500495269300_R8","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1007\/s40258-017-0336-8","article-title":"The role of cost on failure to access prescribed pharmaceuticals \u2013 the case of statins.","volume":"15","author":"McRae","year":"2017","journal-title":"Appl Health Econ Health Policy"},{"key":"2025121500495269300_R9","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1002\/pds.3526","article-title":"Factors influencing adherence in long-term use of statins.","volume":"22","author":"Warren","year":"2013","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2025121500495269300_R10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0140008","article-title":"Association of continuity of primary care and statin adherence.","volume":"10","author":"Warren","year":"2015","journal-title":"PLoS One"},{"key":"2025121500495269300_R11","unstructured":"Department of Social Services. DSS payment demographic data. 2015. Available at: https:\/\/data.gov.au\/dataset\/ds-dga-cff2ae8a-55e4-47db-a66d-e177fe0ac6a0\/distribution\/dist-dga-6b3fba11-2f71-4df9-963d-fce31a7e59e3\/details?q= [verified 30 January 2019]."},{"key":"2025121500495269300_R12","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1093\/ije\/dym184","article-title":"Cohort profile: the 45 and up study.","volume":"37","author":"45 and Up Study Collaborators","year":"2008","journal-title":"Int J Epidemiol"},{"key":"2025121500495269300_R13","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1016\/j.amjhyper.2006.04.006","article-title":"Medication adherence and persistence as the cornerstone of effective antihypertensive therapy.","volume":"19","author":"Burnier","year":"2006","journal-title":"Am J Hypertens"},{"key":"2025121500495269300_R14","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1161\/CIRCULATIONAHA.110.983874","article-title":"Meta-analysis: impact of drug class on adherence to antihypertensives.","volume":"123","author":"Kronish","year":"2011","journal-title":"Circulation"},{"key":"2025121500495269300_R15","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.1016\/j.clinthera.2011.07.016","article-title":"Adherence to oral antidiabetic agents with pioglitazone and metformin: comparison of fixed-dose combination therapy with monotherapy and loose-dose combination therapy.","volume":"33","author":"Barner","year":"2011","journal-title":"Clin Ther"},{"key":"2025121500495269300_R16","doi-asserted-by":"publisher","first-page":"361","DOI":"10.2217\/ijr.12.41","article-title":"What can be done to maximise adherence of biphosphonates in patients with osteoporosis?","volume":"7","author":"Rampakakis","year":"2012","journal-title":"Int J Clin Rheumtol"},{"key":"2025121500495269300_R17","first-page":"110","article-title":"Osteoporosis: pharmacological prevention and management in older people.","volume":"41","author":"Bell","year":"2012","journal-title":"Aust Fam Physician"},{"issue":"2","key":"2025121500495269300_R18","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1111\/1475-6773.12700","article-title":"Effect of out-of-pocket cost on medication initiation, adherence, and persistence among patients with yype 2 diabetes: The Diabetes Study of Northern California (DISTANCE).","volume":"53","author":"Karter","year":"2018","journal-title":"Health Serv Res"},{"key":"2025121500495269300_R19","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1007\/s11606-010-1609-1","article-title":"Healthy user and related biases in observational studies of preventive interventions: a primer for physicians.","volume":"26","author":"Shrank","year":"2011","journal-title":"J Gen Intern Med"}],"container-title":["Australian Health Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/ah\/article-pdf\/44\/2\/270\/436732\/ah18146.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/ah\/article-pdf\/44\/2\/270\/436732\/ah18146.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T05:50:00Z","timestamp":1765777800000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/ah\/article\/44\/2\/270\/70290\/Failure-to-access-prescribed-pharmaceuticals-by"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,4]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,4,3]]}},"URL":"https:\/\/doi.org\/10.1071\/ah18146","relation":{},"ISSN":["0156-5788","1449-8944"],"issn-type":[{"value":"0156-5788","type":"print"},{"value":"1449-8944","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,4]]}}}