{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:44:45Z","timestamp":1777859085600,"version":"3.51.4"},"reference-count":33,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2014,11,26]],"date-time":"2014-11-26T00:00:00Z","timestamp":1416960000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:p>Objectives: Medication adherence is an important determinant of successful medical treatment. Marginalized populations, such as homeless and vulnerably housed individuals, may face substantial barriers to medication adherence. This study aimed to determine the prevalence of, reasons for, and factors associated with medication nonadherence among homeless and vulnerably housed individuals. Additionally, we examined the association between medication nonadherence and subsequent emergency department utilization during a 1-year follow-up period. Methods: Data were collected as part of the Health and Housing in Transition study, a prospective cohort study tracking the health and housing status of 595 homeless and 596 vulnerably housed individuals in 3 Canadian cities. Logistic regression was used to identify factors associated with medication nonadherence, as well as the association between medication nonadherence at baseline and subsequent emergency department utilization. Results: Among 716 participants who had been prescribed a medication, 189 (26%) reported nonadherence. Being \u226540 years old was associated with decreased likelihood of nonadherence (adjusted odds ratio [AOR] = 0.59; 95% confidence interval [CI] = 0.41-0.84), as was having a primary care provider (AOR = 0.49; 95% CI = 0.34-0.71). Having a positive screen on the AUDIT (Alcohol Use Disorders Identification Test; an indication of harmful or hazardous drinking) was associated with increased likelihood of nonadherence (AOR = 1.86; 95% CI = 1.31-2.63). Common reasons for nonadherence included side effects, cost, and lack of access to a physician. Self-reported nonadherence at baseline was significantly associated with frequent emergency department use (\u22653 visits) over the follow-up period at the bivariate level (OR = 1.55; 95% CI = 1.02-2.35) but was not significant in a multivariate model (AOR = 1.49; 95% CI = 0.96-2.32). Conclusion: Homeless and vulnerably housed individuals face significant barriers to medication adherence. Health care providers serving this population should be particularly attentive to nonadherence among younger patients and those with harmful or hazardous drinking patterns.<\/jats:p>","DOI":"10.1177\/2150131914560610","type":"journal-article","created":{"date-parts":[[2014,11,26]],"date-time":"2014-11-26T22:46:39Z","timestamp":1417041999000},"page":"154-161","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":53,"title":["Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities"],"prefix":"10.1177","volume":"6","author":[{"given":"Charlotte E.","family":"Hunter","sequence":"first","affiliation":[{"name":"Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita","family":"Palepu","sequence":"additional","affiliation":[{"name":"Centre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Farrell","sequence":"additional","affiliation":[{"name":"University of Ottawa, Institute of Mental Health Research, Ottawa, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evie","family":"Gogosis","sequence":"additional","affiliation":[{"name":"Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen W.","family":"Hwang","sequence":"additional","affiliation":[{"name":"Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2014,11,26]]},"reference":[{"key":"bibr1-2150131914560610","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra050100"},{"key":"bibr2-2150131914560610","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000114908.90348.f9"},{"key":"bibr3-2150131914560610","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2710.2001.00363.x"},{"key":"bibr4-2150131914560610","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.92.7.1120"},{"key":"bibr5-2150131914560610","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.4.421"},{"key":"bibr6-2150131914560610","doi-asserted-by":"publisher","DOI":"10.1176\/ps.2009.60.5.601"},{"key":"bibr7-2150131914560610","volume-title":"Adherence to Long-Term Therapies: Evidence for Action","author":"Sabate E","year":"2003"},{"key":"bibr8-2150131914560610","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.111270"},{"key":"bibr9-2150131914560610","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijlp.2005.08.003"},{"key":"bibr10-2150131914560610","doi-asserted-by":"publisher","DOI":"10.2190\/4M3E-L0YF-W1TD-EKG0"},{"key":"bibr11-2150131914560610","doi-asserted-by":"publisher","DOI":"10.1097\/00006205-198908000-00008"},{"key":"bibr12-2150131914560610","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2009.180109"},{"key":"bibr13-2150131914560610","unstructured":"Khandor E, Mason K, Cowan L. The Street Health Report 2007. Toronto, Ontario, Canada: Street Health and the Wellesley Institute; 2007. http:\/\/www.urbancenter.utoronto.ca\/pdfs\/communitydevelopment\/CD_Seminar-StreetHealth-Oct30.pdf. Accessed November 4, 2014."},{"key":"bibr14-2150131914560610","doi-asserted-by":"publisher","DOI":"10.1007\/s00038-011-0283-3"},{"key":"bibr15-2150131914560610","unstructured":"Ontario Ministry of Health and Long-Term Care. The Ontario Drug Benefit (ODB) Program. http:\/\/www.health.gov.on.ca\/en\/public\/programs\/drugs\/programs\/odb\/odb.aspx. Accessed August 3, 2012."},{"key":"bibr16-2150131914560610","unstructured":"British Columbia Ministry of Health. PharmaCare. http:\/\/www.health.gov.bc.ca\/pharmacare\/generalinfo\/generalinfoindex.html. Accessed August 3, 2012."},{"key":"bibr17-2150131914560610","unstructured":"Ontario Ministry of Health and Long-Term Care. Trillium Drug Program (TDP). http:\/\/www.health.gov.on.ca\/en\/public\/programs\/drugs\/programs\/odb\/opdp_trillium.aspx. Accessed August 3, 2012."},{"key":"bibr18-2150131914560610","first-page":"109","volume":"27","author":"Ardilly P","year":"2001","journal-title":"Survey Methodol"},{"key":"bibr19-2150131914560610","unstructured":"Statistics Canada. Ethnic Diversity Survey: Portrait of a Multicultural Society. Ottawa, Ontario, Canada: Statistics Canada, Housing, Family and Social Statistics; 2003. Catalogue no. 89-593-XIE. http:\/\/www.statcan.gc.ca\/pub\/89-593-x\/89-593-x2003001-eng.pdf. Accessed November 4, 2014."},{"key":"bibr20-2150131914560610","unstructured":"Statistics Canada. Canadian Community Health Survey (CCHS). Ottawa, Ontario, Canada: Statistics Canada; 2011. http:\/\/www23.statcan.gc.ca\/imdb\/p2SV.pl?Function=getSurvey&SDDS=3226&lang=en&db=imdb&adm=8&dis=2. 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