hispanic medication adherence studyholadoctor.net/pdf/white-paper/holadoctor hispanic... ·...

HISPANIC MEDICATION ADHERENCE STUDY

HISPANIC MEDICATION ADHERENCE | 1

TABLE OF CONTENTS

EXECUTIVE SUMMARY .......................................................................................................................................................................................... 2

INTRODUCTION ...................................................................................................................................................................................................... 4

STUDY OBJECTIVES .............................................................................................................................................................................................. 4

STUDY DESIGN AND METHODOLOGIES ............................................................................................................................................................. 5

PROVIDER KEY INFORMANT INTERVIEW RESULTS .......................................................................................................................................... 6

Insights from the Key Informants ......................................................................................................................................................................... 7

SURVEY RESULTS ................................................................................................................................................................................................ 10

When you don’t take your medication, what is the main reason you don’t take it? ....................................................................................... 17

Affordability .................................................................................................................................................................................................... 17

Ways to Improve Medication Adherence ....................................................................................................................................................... 17

What helps you remember your medication? ................................................................................................................................................ 18

What would help Hispanics take their medication? ....................................................................................................................................... 19

SUMMARY AND RECOMMENDATIONS ............................................................................................................................................................... 20

6RPH�RI�WKH�NH\�¿QGLQJV�ZH�FDQ�GUDZ�IURP�RXU�UHVHDUFK�DUH�WKH�IROORZLQJ ...................................................................................................... 20

Recommendations ......................................................................................................................................................................................... 21

Action items ................................................................................................................................................................................................... 21

ABOUT THE AUTHORS ......................................................................................................................................................................................... 22

About HolaDoctor ............................................................................................................................................................................................... 22

About EnvisionRx ............................................................................................................................................................................................... 22

About the Authors ............................................................................................................................................................................................... 22

CONTACTS ............................................................................................................................................................................................................ 23

EXHIBIT 1: HISPANIC MEDICATION ADHERENCE STUDY – COMPLETE RESPONSES TO ALL QUESTIONS .............................................. 24

Section A: Total Responses ............................................................................................................................................................................... 24

Section B: Demographics ................................................................................................................................................................................... 24

Section C: Medical History ................................................................................................................................................................................. 28

Section D: MMAS ............................................................................................................................................................................................... 30

Section E: Initial Prescription ............................................................................................................................................................................. 32

6HFWLRQ�)��)XO¿OOPHQW .......................................................................................................................................................................................... 35

Section G: Adherence ........................................................................................................................................................................................ 36

REFERENCES ....................................................................................................................................................................................................... 39

Call Us: 1-877-846-5237Visit Us: www.holadoctor.net


EXECUTIVE SUMMARY

Introduction: Hispanics are the largest and one of the fastest-growing minority groups in the United States. Hispanics have

higher rates of certain medical conditions, e.g., diabetes, than non-Hispanic whites. For nearly all conditions, Hispanics have

lower medication adherence than non-Hispanic whites. A limited number of interventions have been tested to increase medication

FRPSOLDQFH� DPRQJ� +LVSDQLFV�� EXW� WKHUH� LV� VWLOO� YHU\� SRRU� XQGHUVWDQGLQJ� RI� ZK\� +LVSDQLFV� GR� QRW� ¿OO� DQG�RU� DGKHUH� WR� WKHLU�medication condition management protocols.

Objectives: The overall objective of the study was to increase our understanding of how this increasingly dominant demographic

JURXS�XVH�DQG�DGKHUH�WR�PHGLFDWLRQ�SURWRFROV��6SHFL¿F�REMHFWLYHV�ZHUH�WR��*DLQ�D�EHWWHU�XQGHUVWDQGLQJ�RI�PHGLFDWLRQ�DGKHUHQFH�DPRQJ�+LVSDQLFV��2EWDLQ�D�GHHSHU�XQGHUVWDQGLQJ�RI�WKH�ZD\V�LQ�ZKLFK�ODQJXDJH�GHWHUPLQHV�KRZ�+LVSDQLFV�DUH�HGXFDWHG�DERXW�DQG�XVH�SUHVFULEHG�PHGLFDWLRQV��(OLFLW�UHFRPPHQGDWLRQV�IURP�VXEMHFW�PDWWHU�H[SHUWV�DV�ZHOO�DV�+LVSDQLFV�WKHPVHOYHV�RQ�KRZ�WR�LQFUHDVH�PHGLFDWLRQ�DGKHUHQFH�DQG��3URSRVH�SUDFWLFDO�DSSURDFKHV�WR�WUDQVODWLQJ�WKHVH�LQVLJKWV�LQWR�DFWLRQDEOH�LQWHUYHQWLRQV��

Design and Methodologies: 7KH�+LVSDQLF�0HGLFDWLRQ�6WXG\�UHOLHG�RQ�WKUHH�NH\�VRXUFHV�RI�LQIRUPDWLRQ��$�OLWHUDWXUH�UHYLHZ�XVLQJ�KHDOWK�DQG�PHGLFDO�SXEOLFDWLRQV��.H\�LQIRUPDQW�LQWHUYLHZV�ZLWK�VXEMHFW�PDWWHU�H[SHUWV�LQ�WKH�DUHD�RI�+LVSDQLF�KHDOWK�DQG��$Q�RQOLQH�VXUYH\�¿HOGHG�WR�+ROD'RFWRU¶V�GDWDEDVH�RI�RYHU�RQH�PLOOLRQ�+LVSDQLF�KHDOWK�VHHNHUV�UHVLGLQJ�LQ�WKH�8�6��DQG�3XHUWR�5LFR��

Findings and Results from Literature Review and Key Informant Interviews:�7KH�¿QGLQJV�IURP�WKH�OLWHUDWXUH�UHYLHZ�DQG�NH\�informant interviews offered a number of common insights and the barriers to good medication adherence. Among these were that:

+LVSDQLFV�WHQG�WR�³ZDLW´� WR�EULQJ�WKHPVHOYHV�RU� WKHLU� IDPLO\�PHPEHUV�WR�VHH�D�GRFWRU��RIWHQ�WU\LQJ�DOWHUQDWLYH�QDWXUDO�DSSURDFKHV�¿UVW��ORZ�KHDOWK�OLWHUDF\�KDV�D�QHJDWLYH�LPSDFW�RQ�KHDOWK�VHHNLQJ�DQG�DGKHUHQFH��YLVLWV�WR�GRFWRUV�DUH�DYRLGHG�EHFDXVH�HPSOR\PHQW�LV�PRUH�OLNHO\�WR�EH�KRXUO\�ZDJH�EDVHG�DQG�LI�WKH\�DUHQ¶W�ZRUNLQJ��WKH\�DUHQ¶W�HDUQLQJ�PRQH\��WKHUH�LV�D�ORZ�XQGHUVWDQGLQJ�RI�KRZ�prescribed medications work or what they are for and how they are to be taken, all leading to distrust they will work and lower

DGKHUHQFH��WKHUH�LV�D�JUHDWHU�FRQFHUQ�DERXW�VLGH�HIIHFWV�ZLWK�SUHVFULEHG�PHGLFDWLRQV�DPRQJ�+LVSDQLFV�FRPSDUHG�WR�QRQ�+LVSDQLF�ZKLWHV�� FRVW� RI� FRSD\V�FDQ�EH�D� VHULRXV�GHWHUUHQW� IRU� ORZHU� LQFRPH�+LVSDQLFV��5HJDUGLQJ� ³ZKDW�ZRUNV´� WR� LQFUHDVH�DGKHUHQFH��WDFWLFV�LQFOXGHG��KRPH�YLVLWV�E\�OD\�KHDOWK�ZRUNHUV��FRQGXFWLQJ�³VKRZ�DQG�WHOO´�VHVVLRQV�ZLWK�+LVSDQLF�SDWLHQWV��ZKHUH�WKH�SDWLHQW�RU�FDUHWDNHU�LV�PDGH�WR�KDQGOH�HDFK�PHGLFDWLRQ�DQG�WHOO�WKH�SURYLGHU�ZKDW�HDFK�LV��KRZ�LW�LV�XVHG�DQG�ZKDW�LW�LV�IRU��UHPLQGHUV��LQFOXGLQJ�text messaging, are showing promise.

Online Survey — Participants: We conducted an online survey with a total of 1,712 participants, 870 of whom were living in

3XHUWR�5LFR�DQG��RI�ZKRP�ZHUH�LQ�WKH�8QLWHG�6WDWHV��)LIW\�RQH�SHUFHQW�ZHUH�EHWZHHQ��DQG��\HDUV�RI�DJH��SHUFHQW�RI�survey respondents spoke Spanish at home. Three-quarters of the participants had some form of health insurance. Approximately

45 percent of the sample were taking three or more medications on a regular basis. High blood pressure, pain, high cholesterol,

GLDEHWHV�DQG�DFLG�UHÀX[�ZHUH�WKH�WRS�FRQGLWLRQV��

Online Survey — Findings and Results: Survey participants in the U.S. reported feeling more disconnected from their doctor

than those in Puerto Rico due to cultural and language barriers. Doctors were by far the preferred source of information about



medications with over 70 percent of respondents preferring a doctor for information on medications in both the U.S. and Puerto Rico.

Conversely, pharmacists were preferred by 24 percent of Puerto Rican respondents compared to just 13 percent of Hispanics in the

U.S. Less than a third of Hispanics ranked high on a standardized medication adherence scale: two-thirds were either moderate

RU�SRRU�DGKHUHUV��7KH�WRS�UHDVRQV�IRU�QRW�WDNHQ�RQHV�PHGLFDWLRQV�ZHUH��,�IRUJHW��SHUFHQW��,�IHOW�EHWWHU��SHUFHQW��KLJK�FRVW��SHUFHQW��2QOLQH�LQIRUPDWLRQ��HPDLO�DQG�WH[W�PHVVDJLQJ�ZHUH�WKH�WRS�WKUHH�WKLQJV�+LVSDQLFV�IHOW�ZRXOG�KHOS�WKHP�UHPHPEHU�WR�WDNH�PHGLFDWLRQV��7KH�WRS�¿YH�ZD\V�WKDW�SHRSOH�UHPHPEHUHG�WR�WDNH�WKHLU�PHGLFDWLRQV�ZHUH��SDLQ�IHHOLQJ�ZRUVH��KDYLQJ�D�URXWLQH��alarm or calendar reminders, putting the medications out so they can be seen and knowing they are important for health and

feeling better. When asked what participants thought would help other Hispanics have higher medication adherence, the strongest

recommendation, by far, was more education and information about the condition and the medication itself.

RECOMMENDATIONS AND ACTION ITEMS

Health care providers, health plans and others professionals designing interventions to increase medication adherence among

Hispanics should consider the following:

• Hispanics have told us loud and clear, they need more and better understanding of their medical conditions and the

medications they are being prescribed.

• While non-Hispanics tend to accept information from a wide range of sources, among Hispanics, the doctor is still king.

• Routines, alarms, calendars and simply putting medicines in a place that is easy to see are considered the most effective

tactics for remembering to take one’s treatments.

• Hispanics are connected, mobile and technologically savvy. Online information, emails and text messages were all considered

good ways to receive information and reminders.

Some things that health care educators and providers should do based on this study include:

• Creating information about standard medications and conditions that doctors can give to their patients in the exam rooms —

this is a fast way for doctors to deliver information.

• Providing reminder tools through online and mobile technology to remind individuals to take their medications or take their

medications with them.

�� 3DLULQJ�PHGLFDWLRQ�¿QDQFLDO�DVVLVWDQFH�SURJUDPV�ZLWK�LQIRUPDWLRQ�UHJDUGLQJ�FRQGLWLRQV�VR�WKDW�SDWLHQWV�FDQ�DFFHVV�information and understand how to use their medication.



INTRODUCTION

Hispanics are the largest and one of the fastest-growing minority groups in the United States1. By 2025, over 25 percent of the U.S.

population is projected to be of Hispanic ethnicity. Hispanics have traditionally had the lowest rates of health insurance coverage of

any demographic group2��$Q�HVWLPDWHG�HLJKW�LQ��XQLQVXUHG�+LVSDQLFV�TXDOL¿HG�IRU�0HGLFDLG��WKH�&KLOGUHQ¶V�+HDOWK�,QVXUDQFH�3ODQ��&+,3��RU�ORZHU�FRVWV�RQ�PRQWKO\�SUHPLXPV�WKURXJK�WKH�+HDOWK�,QVXUDQFH�0DUNHWSODFH��6LQFH�WKH�SDVVDJH�RI�WKH�$IIRUGDEOH�&DUH�$FW��PLOOLRQ�+LVSDQLFV��DJHV��KDYH�JDLQHG�KHDOWK�LQVXUDQFH�FRYHUDJH��ORZHULQJ�WKH�XQLQVXUHG�UDWH�DPRQJ�+LVSDQLFV�E\��percent. If all states took advantage of new opportunities to expand Medicaid coverage under the Affordable Care Act, 95 percent

of eligible uninsured Hispanics might qualify for Medicaid, CHIP or programs to help lower the cost of health insurance coverage in

the Marketplace.3

Hispanics have higher rates of certain medical conditions, e.g., diabetes, than non-Hispanic whites4. For nearly all conditions,

Hispanics have lower medication adherence than non-Hispanic whites5. Medication adherence among Hispanics is lower among

Hispanics with heart disease6,7,8 and diabetes9, among other conditions. Hispanic Medicare recipients10,11 and those on psychotropic12

WUHDWPHQWV�DOVR�VKRZ�VLJQL¿FDQWO\�ORZHU�FRPSOLDQFH�ZLWK�PHGLFDWLRQ�UHJLPHQV�WKDQ�QRQ�+LVSDQLF�ZKLWHV��

Empirical data on the attitudes, beliefs and practices of uninsured Hispanics and the use of discount medication programs are

severely lacking. A limited number of interventions have been tested to increase medication compliance among Hispanics13, but

WKHUH� LV�VWLOO� YHU\�SRRU�XQGHUVWDQGLQJ�RI�ZK\�+LVSDQLFV�GR�QRW�¿OO� WKHLU�SUHVFULSWLRQV�DQG�RU�DGKHUH� WR� WKHLU�PHGLFDWLRQ�FRQGLWLRQ�management protocols. This study seeks to increase our understanding of how this increasingly dominant demographic group uses

and adheres to medication protocols.

STUDY OBJECTIVES

The objectives of this study were to:

• Gain a better understanding of medication adherence among Hispanics

• Obtain a deeper understanding of the ways in which language determines how Hispanics are educated about

and use prescribed medications

• Elicit recommendations from subject matter experts as well as Hispanics themselves on how to increase

medication adherence

• Propose practical approaches to translating these insights into actionable interventions



STUDY DESIGN AND METHODOLOGIES

The Hispanic Medication Study relied on three key sources of information:

• A literature review using health and medical publications

• Key informant interviews with subject matter experts in the area of Hispanic health

• An online survey ¿HOGHG�WR�+ROD'RFWRU¶V�GDWDEDVH�RI�RYHU�RQH�PLOOLRQ�+LVSDQLF�KHDOWK�VHHNHUV�UHVLGLQJ�LQ�WKH�U.S. and Puerto Rico

,Q�WKLV�UHSRUW��ZH�LQFOXGH�WKH�FRPSUHKHQVLYH�¿QGLQJV�IURP�WKHVH�WKUHH�DSSURDFKHV��$�YHUVLRQ�RI�WKH�VWXG\�UHVXOWV�ZLOO�EH�SXEOLVKHG�DV�D�VKRUWHU�ZKLWH�SDSHU�DV�ZHOO�DV�LQ�DQ�DFDGHPLF��SHHU�UHIHUHQFHG�MRXUQDO�DUWLFOH��IRUWKFRPLQJ��

Online Study Population: HolaDoctor operates the largest network of Spanish-language health care websites on the Internet, with over

3.5 million unique Hispanic visitors monthly. Approximately one million of these unique Hispanic visitors reside in the U.S. or Puerto Rico.

HISPANICS ARE ONLINE AND MOBILEUntil recently, online surveys among Hispanics may have missed the lowest-income consumers, who did not have Internet access. Today, however, nearly 78 percent of Hispanics in the U.S. and Puerto Rico report using the Internet. As with the general market, a large and very fast-growing percentage of these consumers access the Internet through their smartphones or other web-enabled mobile devices. Of the more than millions of pages of Spanish-language health information HolaDoctor serves up each month, over 70 percent are accessed through consumers’ mobile devices, and 76 percent of Hispanic Internet users report accessing the Internet through a mobile device.14



Instrument Development:� 7KH� VXUYH\� LQVWUXPHQW� ZDV� EDVHG� RQ� EHVW� SUDFWLFHV� LQ� WKH�PHGLFDWLRQ� DGKHUHQFH� ¿HOG�� 7KH� RQOLQH�questionnaire included demographic questions, the core set of questions from the MM4 questionnaire15 , culturally relevant questions

particular to Hispanics and open-ended questions to elicit innovative strategies and tactics. A number of subject matter experts

SURYLGHG�LQSXW�RQ�WKH�VXUYH\�TXHVWLRQ�VHW��7KH�¿QDO�VXUYH\�FRQWDLQHG�TXHVWLRQV�RQ�GHPRJUDSKLFV��KHDOWK�FRQGLWLRQV��PHGLFDWLRQ�usage, attitudes, barriers and enablers to better medication compliance.

Recruitment: Hispanic consumers who had opted into to HolaDoctor’s online community were invited to participate in the survey

through an email invitation. Participants who completed the survey were provided with a $10 Amazon gift card. The survey was

¿HOGHG�RYHU�WZR�URXQGV��RQH�GXULQJ�1RYHPEHU��DQG�D�VHFRQG�GXULQJ�-DQXDU\��

Analysis: )UHTXHQFLHV� WDEOHV� ZHUH� JHQHUDWHG� DQG� VWUDWL¿HG� E\� UHVLGHQFH� �3XHUWR� 5LFR� YV�� 8�6�� PDLQODQG�� 'LIIHUHQFHV� ZHUH�GHWHUPLQHG�XVLQJ�FKL�VTXDUH�DW�WKH�S��VLJQL¿FDQFH�OHYHO��

PROVIDER KEY INFORMANT INTERVIEW RESULTS

Three physicians who regularly care for Hispanic patients participated in the in-depth interviews:

• Dr. Eduardo Montana. Pediatric cardiologist and current chair of the Hispanic Health Coalition of Georgia

• Dr. Flavia Mercado. A pediatrician and former chair of the Hispanic Health Coalition of Georgia

• Dr. Ken Dominguez��$�GLUHFWRU�RI�+,9�$,'6�DW�WKH�&HQWHUV�IRU�'LVHDVH�&RQWURO�DQG�3UHYHQWLRQ�DQG�FKDLU�RI�WKH�CDC Hispanic employees working group

7KHVH�VXEMHFW�PDWWHU�H[SHUWV�SURYLGHUV�ZHUH�LQWHUYLHZHG�DERXW�WKH�EDUULHUV�WR�PHGLFDWLRQ�DGKHUHQFH�DPRQJ�+LVSDQLFV�DQG��PRUH�importantly, what they have found works to increase adherence among this population. These key informants also provide input on

the content of the survey instrument.



INSIGHTS FROM THE KEY INFORMANTS

The qualitative insights and examples provided by the key informant physicians have been grouped by topic below.

ATTITUDES TOWARD MEDICATIONS AND HESITANCY TO GO TO THE DOCTOR

• Hispanics wait to bring children to the doctor.

• Hispanics need to work and are often paid by the hour, so they are very reluctant to take time to go to the doctor.

• They know going to the doctor “opens up a whole process.” They are hesitant to “get into it all.”

LANGUAGE BARRIERS

�� (YHQ�LI�WKH�GRFWRU�VSHDNV�6SDQLVK��WKH\�VWLOO�RIWHQ�GRQ¶W�XQGHUVWDQG�ZKDW�WKH�GRFWRU�LV�VD\LQJ��,W�LV�PRUH�WKDQ�ODQJXDJH��LW�LV�also “health literacy.”

PERSISTENCE

�� 5H¿OOV�±�WKH\�XVXDOO\�¿OO�WKH�¿UVW�VFULSW��EXW�WKHQ�GRQ¶W�UH¿OO�LW��

• Hispanics are more apt to share medicines.

CHRONIC CONDITIONS

• Chronic conditions are really tough because they need to keep track of so many medications for such a long period.

• They don’t understand that patients have to be on some medications for a long time.

• Asthma. They take curative medication, but they do not consistently take the maintenance meds.

• Case study: Diabetic teen on metformin. His whole family was diabetic. He didn’t take his meds because he didn’t feel bad.

He didn’t understand why he should take it.

CONFLICT WITH SCHOOL

�� 6FKRROV�FDQ�PDNH�WKH�SURFHVV�HYHQ�PRUH�FRPSOLFDWHG��7KH�GRFWRU�DQG�IDPLO\�QHHG�WR�VXEPLW�OHWWHUV�DQG�KDYH�WR�EH�LGHQWL¿HG��so sometimes they just want to avoid the whole situation by not reporting asthma to the school.

�� $VWKPD�LV�WKH�ELJJHVW�FKURQLF�SUREOHP�ZLWK�FKLOGUHQ��:H��GRFWRUV��VWDUW�E\�WHDFKLQJ�WKH�SDUHQWV��EXW�³HYHQWXDOO\�ZH�QHHG�WR�teach the children.”

�� ³:H�SURYLGHUV�WKLQN�WKDW�FRPSOLDQFH�LV�WKH�PRVW�LPSRUWDQW��EXW�WKH\��WKH�SDUHQWV�DQG�NLGV��DUH�GHDOLQJ�ZLWK�ORWV�RI�RWKHU�WKLQJV��like just getting to school.”



UNDERSTANDING MEDICATIONS

• Hispanics are very visual. They often just refer to the color of the pills — white pill, blue pill — but of course lots of pills are the

same color, so that can create problems.

• Some doctors use a visual graph or the PDR.

• I had a patient whose child should be on ADHD meds, but the mom just didn’t want to have her child take it. She resisted and

kept bringing in folk remedies.

• It’s very important that they understand WHY they are taking the medicines. This can be a real issue with Hispanic patients.

POOR UNDERSTANDING OF HOW TO USE MEDICATIONS

• Hispanics often have a very poor understanding of what medicines they have been prescribed and how to take them.

• It’s not uncommon that they put ear drops in the mouth.

• Case study of asthma patient: The child was admitted to the hospital, which gave the parents medications. The mother

already had some medications from the doctor and then got additional medications from the emergency room. The mother

was very confused, so she came to her provider. “I’m not sure which of all these medicines to give my son. I got one from

doctor and one from the hospital,” she said. She brought three bags in to the doctor. She had medications from the doctor,

hospital and emergency room. Some were the same medications, but some were generic and some brand name. Hispanics

often get medications from Walmart that often don’t get recorded in the health plan records.

• What works best is to have them bring all of their medications in to the appointments and have the doctor explain what each

one is for and how they are to be taken.

• In AIDS, the large number of pills is an issue. It works much better if pills can

be combined so they take fewer pills fewer times per day.

• Elderly Hispanics: Need to use a large font and make the instructions clear.



SIDE EFFECTS

• Hispanics tend to be very afraid of side effects from Western medicines, but don’t like to complain. But also it is likely that they

just don’t complain to me because I am the doctor.

• The key is to give them a heads up that there may be side effects.

COST

• Medicaid pays for some medications, health insurance others. The doctor has to be very careful to make sure the medications

V�KH�LV�SUHVFULELQJ�DUH�DIIRUGDEOH��RWKHUZLVH��WKH�SDWLHQW�ZRQ¶W�¿OO�RU�UH¿OO�WKHP��

• Cost is the key. If a family is on Medicaid, they will be very compliant. If not, or if they don’t have another form of health

insurance, they won’t.

WILLINGNESS TO TAKE MEDICATIONS

• Antibiotics: Hispanics are very willing to take antibiotics.

• “With kids and medicines, parents are really trying to do the right thing.”

�� ³,�WKLQN�+LVSDQLFV�UHDOO\�GRQ¶W�ZDQW�WR�JLYH�PHGLFLQHV�´�7KH\�IHHO�OLNH�RWKHU�WKLQJV�FDQ�KHOS�¿UVW��OLNH�WUDGLWLRQDO�FXUHV��

WHAT ELSE WORKS?

�� +RPH�YLVLWV�E\�OD\�KHDOWK�ZRUNHUV��WKH\�FDQ�FKHFN�WR�PDNH�VXUH�WKDW�WKH�PHGV�DUH�VWRUHG�SURSHUO\��UHIULJHUDWHG�� and they can do educational follow-up.

• Show and tell: had parents show her how medications were administered.

• Provider recommendations: CDC has found that the strength of the provider recommendation is very important, especially

among pregnant women.

• Reminders: text messaging and phone calls help.



SURVEY RESULTS

Study Population: A total of 1,712 Hispanic consumers

completed the survey. Approximately half of the participants

�Q ��ZHUH�IURP�3XHUWR�5LFR��ZKLOH�WKH�UHVW�ZHUH�OLYLQJ�LQ�WKH�8QLWHG�6WDWHV��Q ��7KH�VWDWHV�ZKHUH�WKH\�OLYHG�ZHUH�WKH�WRS�¿YH�+LVSDQLF�VWDWHV��&DOLIRUQLD��)ORULGD��,OOLQRLV��1HZ�York and Texas.

7KH� PDMRULW\� RI� UHVSRQGHQWV� ZHUH� ZRPHQ� �� SHUFHQW��The age distribution of the respondents is presented in the

second graph at right. Nearly half of respondents were over

45 years old.

Language: The survey was presented in Spanish to a

community that was initially sourced through Spanish-

language health websites and a free prescription medication

program. It is not surprising, then, that most spoke only

Spanish at home, or a mix of Spanish and English. Less

than one percent spoke only English at home. As expected,

D� VLJQL¿FDQWO\� KLJKHU� SHUFHQWDJH� RI� UHVSRQGHQWV� OLYLQJ� LQ�Puerto Rico spoke only Spanish at home. In a separate

question, 90 percent of participants indicated they prefer to

receive health information in Spanish.

WHICH LANGUAGES DO YOU SPEAK AT HOME?*

United States Puerto Rico Total

English and Spanish equally169 107 276

22% 12% 17%

More Spanish than English309 344 653

40% 40% 40%

More English than Spanish18 6 24

2% 1% 2%

Another language5 0 5

1% 0% 0%

Only Spanish260 405 665

34% 47% 41%

Only English4 2 6

1% <1% <1%

TOTAL 414 408 822

54%

12%

11%

8%

8%

4%

3%

Residence

Puerto Rico

Florida

Other

California

Texas

Illinois

New York

65+5%

5-6417%

45-5426% 35-44

25%

25-3422%

15-245%

Age Distribution

�Q ��



Health Insurance: Over three-quarters of the sample

reported having health insurance. Insurance coverage

ZDV�VLJQL¿FDQWO\�KLJKHU�IRU�WKRVH�OLYLQJ�LQ�3XHUWR�5LFR�� SHUFHQW�� WKDQ� WKRVH� OLYLQJ� LQ� WKH�PDLQODQG� 8�6�� SHUFHQW�� 7KH� SHUFHQWDJH� RI� UHVSRQGHQWV� RQ�Medicaid, 21 percent, matches national statistics,

which show that 68 million of the 316 million people in

the U.S. are covered by Medicaid at some point during

the year16. For those with insurance, people living in

the U.S. were more likely to have coverage through

$IIRUGDEOH�&DUH�$FW�H[FKDQJHV��NQRZQ�WR�+LVSDQLFV�DV� ³2EDPDFDUH´�� ZKLOH� WKRVH� OLYLQJ� LQ� 3XHUWR� 5LFR�were more likely to be covered by private insurance

through a private company.

INSURANCE TYPES FOR THOSE WITH COVERAGE

For those with health insurance, 83 percent indicated that they had prescription drug coverage.


Medicaid79 161 240

20% 22% 21%

Medicare64 118 182

16% 16% 16%

Insurance through an employer or spouse’s employer145 258 403

37% 35% 35%

Private insurance through Obamacare69 43 112

18% 6% 10%

Private insurance bought directly through a private company37 167 204

9% 23% 18%

None335 58 393

44% 7% 24%

TOTAL 762 862 1,624



MEDICAL CONDITIONS AND HISTORY

1HDUO\�DOO�RI�WKH�UHVSRQGHQWV�KDG�RQH�RU�PRUH�PHGLFDO�FRQGLWLRQV�DQG�ZHUH�WDNLQJ�RQH�RU�PRUH�SUHVFULSWLRQ�PHGLFDWLRQV��6HH�EHORZ��

Number of Medical Conditions and Number of Medications Being Taken

Number of Medical Conditions0 12%

1 18%

2 17%

3 17%

4 11%

5 7%

6 to 10 13%

11+ 3%

Number of Medications Being Taken0 14%

1 22%

2 19%

3 14%

4 9%

5 8%

6 to 10 12%

11+ 3%

Number of Medications Prescribed0 13%

1 19%

2 16%

3 16%

4 10%

5 8%

6 to 10 13%

11+ 3%

86%�Q ��

have at least one medical condition and take at least one medication

7KH�PRVW�SUHYDOHQW�PHGLFDO�FRQGLWLRQV�IRU�ZKLFK�SDUWLFLSDQWV�ZHUH�WDNLQJ�PHGLFDWLRQV�ZHUH�KLJK�EORRG�SUHVVXUH��SDLQ��DFLG�UHÀX[�and diabetes. Subjects living in Puerto Rico reported higher usage of medications for conditions.

Which Health Conditions Do You Take Medications For?

0%

10%

20%

30%

40%

50%

8%

18%

15%

20%

23%22%

0%1%1%

19%

22%20%

31%

37%34%

19%

29%

23%

5% 5% 5%

9%

18%

14%

1% 1% 1%

30%

43%

37%

14%

20%

17%

8%

20%

14%

22%24%

23%

Asthma High Cholesterol

COPD Diabetes Pain Acid Reflux Anemia Arthritis Birth Control High Blood Pressure

Mental Health/Depression

Hypo-/Hyperthyroidism

Other

■ United States ■ Puerto Rico ■ Total



MEDICATION COMPLIANCE

The MMAS Score is a validated, standardized set of questions that measure medication adherence15. Notably, a low score indicates

high adherence, while a high score indicates low adherence. About 22 percent of the sample had an MMAS score of 0, so were highly

compliant. Approximately 32 percent of the sample had an MMAS score of 3 or 4, so were deemed to have low medication adherence.

MMAS Scores

0 1 2 3 4

31%

14%

22% 21%

25%23% 22%

24% 23%

17%

23%20%

9%

15%12%

0%

5%

10%

15%

20%

25%

30%

35%

The key questions that make up the MMAS are listed in the following table, along with the percentage of participants answering Yes

or No to each one.


Have you ever forgotten to take medication for your condition?

No330 248 57843% 29% 35%

Yes441 618 1,05957% 71% 65%

TOTAL 771 866 1,637

Have you ever had problems remembering to take your medication?

No503 482 98565% 56% 60%

Yes265 381 64635% 44% 40%

TOTAL 768 863 1,631

When you feel better, do you sometimes stop taking your medications?

No463 516 979

60% 60% 60%

Yes305 349 65440% 40% 40%

TOTAL 768 865 1,633

If you feel worse when taking your medication, do you stop taking it?

No486 475 96163% 55% 59%

Yes286 390 67637% 45% 41%

TOTAL 772 865 1,637




MEDICATION DISCOUNT CARD

About 40 percent of respondents use a medication discount card to help pay for medications, with a slightly higher usage among

those living in Puerto Rico.

DO YOU USE A DISCOUNT MEDICATION PROGRAM TO HELP PAY FOR YOUR MEDICATION?*


No414 510 924

58% 64% 61%

Yes, I’m in a program sponsored by a pharmaceutical company9 7 16

1% 1% 1%

Yes, I’m in a program sponsored by a pharmacy44 22 66

6% 3% 4%

Yes, I receive a medication discount through the clinic I go to40 5 45

6% 1% 3%

Yes, I use a medication discount card169 221 390

24% 28% 26%

Yes, I’m in a different program that decreases my medication costs38 33 71

5% 4% 5%

TOTAL 714 798 1,512

OF THOSE WHO USE MEDICATION DISCOUNT CARDS, ARE THEY UNIVISION CARDS OR OTHER CARDS?


Other40 26 66

19% 10% 14%

Univision169 235 404

81% 90% 86%

TOTAL 209 261 470

The high percentage of people with medication discount cards who responded that they have a Univision card is due to the fact that

one of the sources of the sample population was people who had signed up for a medication discount card administered by Univision,

EnvisionRx and HolaDoctor.



INTERACTING WITH DOCTORS AND HEALTH PROFESSIONALS ABOUT PRESCRIPTION MEDICATIONS:

THE ROLE OF LANGUAGE

When asked “Do you trust your doctor for information about

prescription medications?,” 83 percent indicated that they

always or usually trust their doctor.

When asked “Have you ever felt disconnected from your doctor

because of your culture?,” 23 percent of those living in the U.S.

said that they had, compared to only eight percent of those living

in Puerto Rico. The fact that nearly all doctors in Puerto Rico are

from the island and speak Spanish, whereas in the U.S. there

are few Spanish-speaking, culturally competent physicians, likely

H[SODLQV�WKLV�VLJQL¿FDQW�GLIIHUHQFH��

HAVE YOU EVER FELT DISCONNECTED FROM YOUR DOCTOR BECAUSE OF YOUR CULTURE?


No569 755 1324

77% 92% 85%

Yes170 63 233

23% 8% 15%

TOTAL 739 818 1,557

,QWHUHVWLQJO\��ZKHQ�SDUWLFLSDQWV�ZHUH�DVNHG� ³+RZ�RIWHQ�GR�\RX�KDYH�GLI¿FXOW\�FRPPXQLFDWLQJ�ZLWK�\RXU�GRFWRU"�´� WKH� UDWHV�ZHUH�similar among respondents in the U.S. and Puerto Rico.

HOW OFTEN DO YOU HAVE DIFFICULTY COMMUNICATING WITH YOUR DOCTOR?


Usually48 35 83

6% 4% 5%

Sometimes149 143 292

20% 17% 18%

Once in a while143 137 280

19% 16% 17%

1HYHU�5DUHO\425 536 961

56% 63% 60%

TOTAL 765 851 1,616



The preferred source of information about medications was overwhelmingly a doctor, but pharmacists were much more highly

regarded in Puerto Rico than in the U.S.

Preferred Source of Information about Medications�Q ��

■ United States ■ Puerto Rico

Doctor Pharmacist Nurse

78%72%

13%

24%

2% 1% 2% 1%5% 3% 1% 1%

Family Member Health Promoter Friend0%

10%

20%

30%

40%

50%

60%

70%

80%

ADHERENCE

Overwhelmingly, the most common reason participants did not take their medication was because they forgot.



When You Don’t Take Your Medication, What Is the Main Reason You Don’t Take It?


0%

10%

20%

30%

40%

50%

Financial UHDVRQV�

too expensive

It’s too GLI¿FXOW�WR�go to the pharmacy

I feel better

I feel worse

Need to JHW�D�UH¿OO

I don’t understand why I have to take it

I forget I don’t need it

anymore

Other 1�$� �,�DOZD\V�WDNH�WKHP�

AFFORDABILITY

1HDUO\��SHUFHQW�RI�WKH�VXUYH\�SDUWLFLSDQWV�IHOW�WKDW�WKHLU�PHGLFDWLRQV�ZHUH�HLWKHU�³XQDIIRUGDEOH´��SHUFHQW��RU�³YHU\�XQDIIRUGDEOH´��SHUFHQW��

WAYS TO IMPROVE MEDICATION ADHERENCE

The survey included a series of questions about things Hispanics felt would help them to remember to take medications. Those

DQVZHULQJ�³\HV´�WR�FORVHG�HQGHG�TXHVWLRQV�DERXW�VSHFL¿F�WDFWLFV�DUH�SUHVHQWHG�LQ�WKH�JUDSKLF�EHORZ��

WAYS TO REMEMBER TO TAKE MEDICATION: PERCENT ANSWERING “YES”�Q ��

ONLINE INFORMATION

United States 87%Puerto Rico 90%

EMAIL REMINDERS


TEXT REMINDERS


@



We also asked the open-ended question “What helps you remember your medication?” The results were grouped and are presented

in the following table. Besides feeling pain or discomfort, the three most common responses referenced the importance of routine,

DODUPV�FDOHQGDUV�DQG�KDYLQJ�WKH�SLOOV�LQ�D�SODFH�ZKHUH�WKH\�FDQ�HDVLO\�EH�VHHQ��

WHAT HELPS YOU REMEMBER YOUR MEDICATION?

Number of Mentions

3DLQ�DQG�RU�IHHOLQJ�ZRUVH 110

Have a certain routine 108

$ODUP�FDOHQGDU�UHPLQGHU 90

6HHLQJ�WKH�PHGLFDWLRQV�SXWWLQJ�WKHP�ZKHUH�WKH\�FDQ�EH�VHHQ 74

.QRZLQJ�LW¶V�LPSRUWDQW�IRU�P\�KHDOWK�ZDQWLQJ�WR�IHHO�EHWWHU 71

)DPLO\�LQGLYLGXDO�UHPLQGV�PH 38

Pillbox 27

2WKHU�UHPLQGHUV��FDOOV��HPDLOV��ZULWWHQ��WH[WV��SKRQH�DSSV� 26

Other 12

%HWWHU�¿QDQFLDO�DFFHVV 2

REPRESENTATIVE QUOTATIONS FROM INDIVIDUALS WHEN ASKED WHAT HELPS THEM REMEMBER THEIR MEDICATION• I have a routine, and I also write it on a note on my fridge to be able to remember.

• Knowing that some medications are necessary to get better from whateverLOOQHVV�RQH�LV�VXHULQJ�IURP�DQG�DYRLG�VRPHWKLQJ�PRUH�VHULRXV�RU�FDXVLQJ�WKH�illness to get worse or become fatal.

• When I’m feeling well, I always remember.

• A family member reminds me, and I note it on my cell phone calendar.

ȏ��0\�VRQ�LV�P\�UHDVRQ�IRU�VWD\LQJ�KHDOWK\��+H�LV�RQO\�ȴYH�\HDUV�ROG��DQG�Ζ�DP�D�widow, so it’s just us.

• I am very forgetful when it comes to taking medications, but if someonereminds me, it helps me to remember.



7KH�¿QDO�TXHVWLRQ�DVNHG�WKH�SDUWLFLSDQWV�ZDV�³:KDW�ZRXOG�KHOS�+LVSDQLFV�WDNH�WKHLU�PHGLFDWLRQ"´�,Q�RWKHU�UHVHDUFK��ZH�KDYH�IRXQG�that this question is revealing in that it takes the focus away from individual respondents and forces them to think about ways that might

work for others like them. The overwhelming majority of responses indicated that Hispanics feel that better education and information

about both the medical condition and the medications would be helpful in improving medication adherence. Alarms, reminders and

URXWLQHV�ZHUH�DOVR�PHQWLRQHG��DV�WKH\�ZHUH�LQ�WKH�SUHYLRXV�TXHVWLRQ��6RPH�VXJJHVWHG�WKDW�EHWWHU�¿QDQFLDO�DVVLVWDQFH�DQG�DFFHVV��H�J��ORZHU�SULFHV��ZRXOG�EH�KHOSIXO��1RWDEO\��RQO\�D�VPDOO�QXPEHU�RI�SHRSOH�IHOW�WKDW�PRUH�LQIRUPDWLRQ�LQ�6SDQLVK�RU�6SDQLVK�VSHDNLQJ�doctors was key to better adherence. This may be because most medication instructions are now available in Spanish.

WHAT WOULD HELP HISPANICS TAKE THEIR MEDICATION?

Number of Mentions0RUH�HGXFDWLRQ�LQIRUPDWLRQ�UHJDUGLQJ�WKH�FRQGLWLRQ�DQG�PHGLFDWLRQ 168

$ODUPV�UHPLQGHUV�WKURXJK�DODUPV�RU�HPDLO 71

%HWWHU�DFFHVV�¿QDQFLDO�KHOS�WR�EX\�PHGLFDWLRQV 63

Establishing a routine 57

7H[W�PHVVDJLQJ�DSSOLFDWLRQV 37

Reminders from family members 28

Other 20

6SDQLVK�ODQJXDJH�PDWHULDOV�LQIRUPDWLRQ 7

2WKHU�ZULWWHQ�WHOHYLVLRQ�UHPLQGHUV 6

%HWWHU�GRFWRUV�GRFWRUV�ZKR�VSHDN�6SDQLVK 5

Pillbox 4

REPRESENTATIVE QUOTATIONS WHEN ASKED “WHAT WOULD HELP HISPANICS TAKE THEIR MEDICATION?”ȏ��%HLQJ�EHWWHU�LQIRUPHG�DQG�NQRZLQJ�WKH�EHQHȴWV�DVVRFLDWHG�ZLWK�WDNLQJ�WKHP��

without ignoring the risks associated with taking them.

• Knowing that in order to make progress as a family, they need to be healthy.

• Educating about the illness and learning more about it.

• First being able to get it, then individually coming up with their own system thathelps them remember to take it.

• Having better access to information in a clear, complete and simple manner,either through a doctor or pharmacist who is trusted.

• Having access to good medical treatment and advice in their own language.



SUMMARY AND RECOMMENDATIONS

This study sought to better understand medication usage and adherence among the fast-growing and increasingly important Hispanic

population. The large survey population was representative of Hispanics living in the U.S. or Puerto Rico and enabled us to compare

and contrast whether there were differences between these two groups.

SOME OF THE KEY FINDINGS WE CAN DRAW FROM OUR RESEARCH ARE THE FOLLOWING

• Among this study population of mostly 25- to 55-year-old Hispanic females, many suffer from a number of medical conditions

and are taking multiple medications for these maladies.

�� /LNH�QRQ�+LVSDQLFV��XQGHUVWDQGLQJ�WKHVH�FRQGLWLRQV�DQG�WKH�SUHVFULEHG�WUHDWPHQWV�FDQ�EH�GLI¿FXOW��0RVW�GR�QRW�WDNH�WKHLU�medications at times.

• Hispanics trust their doctor most for information about their medications. In Puerto Rico, pharmacists are highly trusted.

Notably, nurses were not well trusted for medication information.

• Less than a third of Hispanics ranked high on a standardized medication adherence scale: two-thirds were either moderate or

poor adherers.

• Establishing a routine, setting up alarms and reminders and placing the medications in a place that is easy to see are key

tactics to remember treatments.

• Online information, email reminders and text messaging were all perceived as valuable ways to increase adherence.

• Through an open-ended question set, Hispanics suggested that “better information about the medical conditions as well as

WKH�PHGLFDWLRQV�WKHPVHOYHV´�ZDV�VRUHO\�QHHGHG�DQG�WKDW�KHOSLQJ�SHRSOH�XQGHUVWDQG�WKHVH�EHWWHU�FRXOG�VLJQL¿FDQWO\�LQFUHDVH�medication adherence.



RECOMMENDATIONS

Health care providers, health plans and other professionals designing interventions to increase medication adherence among

Hispanics should consider the following:

• Hispanics have told us loud and clear that they need more and better understanding of their medical conditions and the

medications they are being prescribed.

• While non-Hispanics tend to accept information from a wide range of sources, among Hispanics, the doctor is still king.

• Routines, alarms, calendars and simply putting medicines in a place that is easy to see are considered the most effective

tactics for remembering to take one’s medications.

• Hispanics are connected, mobile and technologically savvy. Online information, emails and text messages were all considered

good ways to receive information and reminders.

ACTION ITEMS

• Create information about standard medications and conditions that doctors can give to their patients in the exam rooms —

this is a fast way for doctors to deliver information.

• Provide reminder tools through online and mobile technology to remind individuals to take their medications or take their

medications with them.

�� 3DLU�PHGLFDWLRQ�¿QDQFLDO�DVVLVWDQFH�SURJUDPV�ZLWK�LQIRUPDWLRQ�UHJDUGLQJ�FRQGLWLRQV�VR�WKDW�SDWLHQWV�FDQ�DFFHVV�LQIRUPDWLRQ�and understand how to use their medication.



ABOUT THE AUTHORS

ABOUT HOLADOCTOR

+ROD'RFWRU�,QF��www.holadoctor.net��LV�WKH�OHDGLQJ�+LVSDQLF�KHDOWK�PDUNHWLQJ�FRPSDQ\�LQ�WKH�8�6��+ROD'RFWRU�RZQV�DQG�RSHUDWHV�WKH�PRVW�SRSXODU�6SDQLVK�ODQJXDJH�KHDOWK�FDUH�ZHEVLWH�RQOLQH��www.holadoctor.com��DQG�LV�WKH�H[FOXVLYH�KHDOWK�SDUWQHU�WR�8QLYLVLRQ�Interactive. The company provides strategic consulting, marketing solutions and culturally relevant programs to health plans,

SURYLGHUV��JRYHUQPHQWDO�DJHQFLHV�DQG�RWKHU�KHDOWK�FDUH�HQWLWLHV��+ROD'RFWRU�KDV�RI¿FHV�LQ�$WODQWD��0LDPL�DQG�0H[LFR�&LW\��

ABOUT ENVISIONRX

(QYLVLRQ5[2SWLRQV� LV�D�KHDOWK�FDUH�DQG�SKDUPDF\�EHQH¿W�PDQDJHPHQW��3%0��FRPSDQ\�KHDGTXDUWHUHG� LQ�7ZLQVEXUJ��2KLR��:H�have over 1,500 employees supporting a rapidly growing membership base of over 23 million members, creating savings for them

as well as thousands of plan sponsors. Rite Aid’s acquisition of Envision in 2015 brings together two national health care companies

that give consumers more pharmacy options and give plan sponsors improved manufacturer relationships and analytic capabilities.

ABOUT THE AUTHORS

Dirk G. Schroeder, ScD, MPH:�'U��6FKURHGHU�LV�WKH�H[HFXWLYH�93�DQG�&KLHI�+HDOWK�2I¿FHU�DW�+ROD'RFWRU�,QF��+H�LV�DOVR�DQ�DGMXQFW�associate professor of global health at Emory University. He is a recognized expert in Hispanic health issues, including ways to

increase access and address health disparities. Dr. Schroeder has lived and worked throughout Latin America as well as Southeast

Asia. He has doctoral and master’s degrees in international health from Johns Hopkins University and a post-doc from Cornell. He

completed his undergraduate work, with honors and distinction, at Stanford University.

Meryam Alaoui: As general manager for EnvisionSavings, the direct-to-consumer line of business for EnvisionRxOptions, a

national, fully integrated health care company, Ms. Alaoui oversees all prescription discount programs and copay buy-down

offerings administered nationally by EnvisionRx. In this capacity, she works with public- and private-sector clients, including states,

PXQLFLSDOLWLHV��QRQSUR¿W�RUJDQL]DWLRQV�DQG�HPSOR\HUV�� WR�GHOLYHU� YDOXDEOH�VHUYLFHV� WR�PRUH� WKDQ��PLOOLRQ� OLYHV��3ULRU� WR� MRLQLQJ�Envision in 2009, Ms. Alaoui held executive roles with American Express in Finance, Operations, Tax, Treasury and Merchant

6HUYLFHV�� %HIRUH�$PHULFDQ� ([SUHVV�� VKH� ZRUNHG� IRU� WKH� 1DWLRQDO� &RXQFLO� RQ� &RPSHQVDWLRQ� ,QVXUDQFH� �1&&,�� RYHUVHHLQJ� WKH�Assigned Risk investment portfolio.

Brianna Keefe-Oates, MPH: Ms. Keefe-Oates serves as part of the strategic consulting branch of HolaDoctor. She has most

recently worked on educational outreach programs focused on educating individuals about the Affordable Care Act. Ms. Keefe-Oates

also has experience implementing health prevention projects with Hispanics in the Southeast U.S. and nationally. Ms. Keefe-Oates

has worked on research and outreach projects in Paraguay and the Dominican Republic, where she spent three years as a Peace

Corps volunteer. Ms. Keefe-Oates received a bachelor’s degree in Latin American studies from Macalester College and a master of

public health degree from Emory University.



CONTACTS

Dr. Dirk G. SchroederPrincipal Investigator

(93��&KLHI�+HDOWK�2I¿FHUHolaDoctor, Inc.

900 Old Roswell Lakes Parkway, Suite 230

Roswell, Georgia 30075

[email protected]

��



EXHIBIT 1: HISPANIC MEDICATION ADHERENCE STUDY – COMPLETE RESPONSES TO ALL QUESTIONS

SECTION A: TOTAL RESPONSES

United States 842 49%

Puerto Rico 870 51%

Grand Total 1,712 100%

SECTION B: DEMOGRAPHICS

SEX*


Female516 649 1165

68% 75% 72%

Male244 212 456

32% 25% 28%

TOTAL 760 861 1,621



AGE


15-2442 39 81

5% 4% 5%

25-34197 171 368

26% 20% 22%

35-44222 191 413

29% 22% 25%

45-54157 270 427

20% 31% 26%

55-64118 156 274

15% 18% 17%

65+34 42 76

4% 5% 5%

TOTAL 770 869 1,639

STATE/TERRITORY RESIDENCE

54%

12%

11%

8%

8%

4%

3%

Puerto Rico

Florida

Other

California

Texas

Illinois

New York



WHICH LANGUAGES DO YOU SPEAK AT HOME?*


English and Spanish equally169 107 276

22% 12% 17%

More Spanish than English309 344 653

40% 40% 40%

More English than Spanish18 6 24

2% 1% 2%

Another language5 0 5

1% 0% 0%

Only Spanish260 405 665

34% 47% 41%

Only English4 2 6

1% <1% <1%

TOTAL 414 408 822

IN WHICH LANGUAGE DO YOU PREFER TO RECEIVE INFORMATION ABOUT YOUR MEDICATIONS?


Spanish675 788 1463

89% 91% 90%

English84 74 158

11% 9% 10%

TOTAL 759 862 1,621

DO YOU CURRENTLY HAVE INSURANCE?**


No335 58 393

44% 7% 24%

Yes427 862 1231

56% 93% 76%

TOTAL 762 862 1,624



FOR THOSE WHO HAVE INSURANCE, WHAT KIND OF INSURANCE?*


Medicaid79 161 240

20% 22% 21%

Medicare64 118 182

16% 16% 16%

Insurance through an employer or spouse’s employer145 258 403

37% 35% 35%

Private insurance through Obamacare69 43 112

18% 6% 10%

Private insurance bought directly through a private company37 167 204

9% 23% 18%

TOTAL 394 747 1141

DOES YOUR INSURANCE COVER YOUR PRESCRIPTION MEDICATIONS?


No67 139 206

16% 18% 17%

Yes346 629 975

84% 82% 83%

TOTAL 413 768 1181



SECTION C: MEDICAL HISTORY

HOW MANY MEDICAL CONDITIONS DO YOU HAVE?

0: 12%

1: 18%

2: 17%

3: 17%

4: 11%

5: 7%

6-10: 13%

11+: 3%

HOW MANY MEDICATIONS ARE YOU CURRENTLY PRESCRIBED?


11+15 38 53

2% 4% 3%

Six to 1076 146 222

9% 17% 13%

Five40 95 135

5% 11% 8%

Four66 99 165

8% 11% 10%

Three128 143 271

15% 16% 16%

Two169 143 271

15% 16% 16%

One193 130 323

23% 15% 19%

Zero155 76 231

18% 9% 13%

TOTAL 842 879 1,712



HOW MANY MEDICATIONS ARE YOU CURRENTLY TAKING?


11+9 33 42

1% 4% 2.5%

Six to 1071 134 205

8% 15% 12%

Five36 94 130

4% 11% 8%

Four63 89 152

7% 10% 9%

Three108 132 240

13% 15% 14%

Two181 149 330

22% 17% 19%

One207 173 380

25% 20% 22%

Zero167 66 233

20% 8% 14%

TOTAL 842 870 1,712

For Which Conditions Are You Currently Prescribed Medication? �5HVSRQGHQWV�ZHUH�DEOH�WR�VHOHFW�PRUH�WKDQ�RQH��


0%

10%

20%

30%

40%

50%

8%

18%

15%

20%

23%22%

0%1%1%

19%

22%20%

31%

37%34%

19%

29%

23%

5% 5% 5%

9%

18%

14%

1% 1% 1%

30%

43%

37%

14%

20%

17%

8%

20%

14%

22%24%

23%

Asthma High Cholesterol

COPD Diabetes Pain Acid Reflux Anemia Arthritis Birth Control High Blood Pressure

Mental Health/Depression

Hypo-/Hyperthyroidism

Other



SECTION D: MMAS

00$6�2YHUDOO�$YHUDJH�� 0RGHUDWHO\�DGKHUHQW� MMAS PR: 2.0

MMAS Other: 1.5

MMAS Scores


0 1 2 3 4

31%

14%

22% 21%

25%23% 22%

24% 23%

17%

23%20%

9%

15%12%

0%

5%

10%

15%

20%

25%

30%

35%

HAVE YOU EVER FORGOTTEN TO TAKE MEDICATION FOR YOUR CONDITION?**


No330 248 578

43% 29% 35%

Yes441 618 1059

57% 71% 65%

TOTAL 771 866 1,637

HAVE YOU EVER HAD PROBLEMS REMEMBERING TO TAKE YOUR MEDICATION?**


No503 482 985

65% 56% 60%

Yes265 381 646

35% 44% 40%

TOTAL 768 863 1,631



WHEN YOU FEEL BETTER DO YOU SOMETIMES STOP TAKING YOUR MEDICATIONS?


No463 516 979

60% 60% 60%

Yes305 349 654

40% 40% 40%

TOTAL 768 865 1,633

IF YOU FEEL WORSE WHEN TAKING YOUR MEDICATION, DO YOU STOP TAKING IT?**


No486 475 961

63% 55% 59%

Yes286 390 676

37% 45% 41%

TOTAL 772 865 1,637



SECTION E: INITIAL PRESCRIPTION

DO YOU USE A DISCOUNT MEDICATION PROGRAM TO HELP PAY FOR YOUR MEDICATION?*


No414 510 924

58% 64% 61%

Yes, I’m in a program sponsored by a pharmaceutical company9 7 16

1% 1% 1%

Yes, I’m in a program sponsored by a pharmacy44 22 66

6% 3% 4%

Yes, I receive a medication discount through the clinic I go to40 5 45

6% 1% 3%

Yes, I use a medication discount card169 221 390

24% 28% 26%

Yes, I’m in a different program that decreases my medication costs38 33 71

5% 4% 5%

TOTAL 714 798 1,512

OF THOSE WHO USE MEDICATION DISCOUNT CARDS, ARE THEY UNIVISION CARDS OR OTHER CARDS?


Other40 26 66

19% 10% 14%

Univision169 235 404

81% 90% 86%

TOTAL 209 261 470



HOW FREQUENTLY DO YOU TRUST THE INFORMATION THAT YOUR DOCTOR GIVES YOU REGARDING YOUR HEALTH

AND MEDICATION?*


Always295 337 632

40% 42% 41%

Usually289 357 646

40% 44% 42%

Sometimes65 69 134

9% 9% 9%


7% 4% 6%

1HYHU�UDUHO\27 12 39

4% 2% 3%

TOTAL 730 809 1,539

HAVE YOU EVER FELT DISCONNECTED FROM YOUR DOCTOR BECAUSE OF YOUR CULTURE?**


No569 755 1324

77% 92% 85%

Yes170 63 233

23% 8% 15%

TOTAL 739 818 1,557



HOW OFTEN DO YOU HAVE DIFFICULTY COMMUNICATING WITH YOUR DOCTOR?


Usually48 35 83

6% 4% 5%


20% 17% 18%


19% 16% 17%

1HYHU�UDUHO\425 536 961

56% 63% 60%

TOTAL 765 851 1616

WHO WOULD YOU PREFER TO GIVE YOU INFORMATION ABOUT HOW TO TAKE YOUR MEDICATION?*


Friend4 1 5

<1% <1% <1%

Doctor611 620 1231

78% 72% 75%

Nurse12 4 16

2% <1% 1%

Family member16 12 28

2% 1% 2%

Pharmacist102 206 308

13% 24% 19%

Health promoter37 22 59

5% 3% 4%

TOTAL 782 865 1647



SECTION F: FULFILLMENT

HOW OFTEN DO YOU HAVE DIFFICULTY COMMUNICATING WITH YOUR PHARMACIST?*


Always30 15 45

4% 2% 3%

Usually29 25 54

4% 3% 3%


14% 12% 13%


15% 12% 14%

1HYHU�UDUHO\502 614 1116

63% 71% 68%

TOTAL 793 860 1653

HOW OFTEN DO YOU HAVE DIFFICULTY REFILLING YOUR PRESCRIPTION?


Always23 6 29

3% 1% 2%

Usually30 21 51

4% 2% 3%


15% 17% 16%


18% 19% 19%

1HYHU�UDUHO\475 524 999

60% 61% 61%

TOTAL 792 859 1651



SECTION G: ADHERENCE

When You Don’t Take Your Medication, What Is the Main Reason You Don’t Take It?

0%

10%

20%

30%

40%

50%

Financial UHDVRQV�

too expensive

It’s too GLI¿FXOW�WR�go to the pharmacy

I feel better

I feel worse

Need to JHW�D�UH¿OO

I don’t understand why I have to take it

I forget I don’t need it

anymore

Other 1�$� �,�DOZD\V�WDNH�WKHP�

HOW AFFORDABLE ARE YOUR PERSONAL MEDICATIONS?*


Very affordable171 119 290

22% 14% 18%

Affordable323 411 734

41% 48% 44%

Unaffordable206 252 458

26% 29% 28%

Very unaffordable95 82 177

12% 10% 11%

TOTAL 795 864 1659

Call Us: 1-877-846-5237 Visit Us: www.holadoctor.net


IF YOU READ ADDITIONAL INFORMATION ONLINE ABOUT YOUR CONDITION AND MEDICATION,

WOULD IT HELP YOU TAKE YOUR MEDICATION?


No103 86 189

13% 10% 11%

Yes691 777 1468

87% 90% 89%

TOTAL 794 863 1657

WOULD EMAIL REMINDERS HELP YOU TAKE YOUR MEDICATION?


No351 369 720

44% 43% 44%

Yes442 492 934

56% 57% 56%

TOTAL 793 861 1654

WOULD TEXT REMINDERS HELP YOU TAKE YOUR MEDICATION?


No157 183 340

42% 40% 41%

Yes221 271 492

59% 60% 59%

TOTAL 378 454 832

WHAT USUALLY HELPS YOU REMEMBER TO TAKE YOUR MEDICATION?

Number of Mentions

3DLQ�DQG�RU�IHHOLQJ�ZRUVH 110

Have a certain routine 108

$ODUP�FDOHQGDU�UHPLQGHU 90

6HHLQJ�WKH�PHGLFDWLRQV�SXWWLQJ�WKHP�ZKHUH�WKH\�FDQ�EH�VHHQ 74

.QRZLQJ�LW¶V�LPSRUWDQW�IRU�P\�KHDOWK�ZDQWLQJ�WR�IHHO�EHWWHU 71

)DPLO\�LQGLYLGXDO�UHPLQGV�PH 38

Pillbox 27

2WKHU�UHPLQGHUV��FDOOV��HPDLOV��ZULWWHQ��WH[WV��SKRQH�DSSV� 26

Other 12

%HWWHU�¿QDQFLDO�DFFHVV 2

Call Us: 1-877-846-5237 Visit Us: www.holadoctor.net


WHAT WOULD HELP HISPANICS TAKE THEIR MEDICATION?

Number of Mentions

0RUH�HGXFDWLRQ�LQIRUPDWLRQ�UHJDUGLQJ�WKH�FRQGLWLRQ�DQG�PHGLFDWLRQ 168

$ODUPV�UHPLQGHUV�WKURXJK�DODUPV�RU�HPDLO 71

%HWWHU�DFFHVV�¿QDQFLDO�KHOS�WR�EX\�PHGLFDWLRQV 63

Establishing a routine 57

7H[W�PHVVDJLQJ�DSSOLFDWLRQV 37

Family or other person helping them to remember 28

Other 20

6SDQLVK�ODQJXDJH�PDWHULDOV�LQIRUPDWLRQ 7

2WKHU�ZULWWHQ�WHOHYLVLRQ�UHPLQGHUV 6

%HWWHU�GRFWRUV�GRFWRUV�ZKR�VSHDN�6SDQLVK 5

Pillbox 4



REFERENCES

1 U.S. Census Community Survey, 2013.

2 U.S. Census Community Survey, 2013.

3��KWWS��ZZZ�KKV�JRY�KHDOWKFDUH�IDFWV�DQG�IHDWXUHV�IDFW�VKHHWV�DFD�ZRUNLQJ�ODWLQR�FRPPXQLW\�LQGH[�KWPO�

4��++6�2I¿FH�RI�0LQRULW\�+HDOWK��

5 Colby JA, Wang F, Chhabra J, Perez-Escamilla R. Predictors of medication adherence in an urban Latino community with healthcare disparities. J ,PPLJU�0LQRU�+HDOWK��$XJ��

6��=KDQJ�<��%DLN�6+��5DFH�HWKQLFLW\��GLVDELOLW\�DQG�PHGLFDWLRQ�DGKHUHQFH�DPRQJ�0HGLFDUH�EHQH¿FLDULHV�ZLWK�KHDUW�IDLOXUH��-�*HQ�,QWHUQ�0HG��$SU��

7��=KDQJ�<��%DLN�6+��&KDQJ�&&��.DSODQ�&0��/DYH�-5��'LVDELOLW\��UDFH�HWKQLFLW\�DQG�PHGLFDWLRQ�DGKHUHQFH�DPRQJ�0HGLFDUH�P\RFDUGLDO�LQIDUFWLRQ�VXUYLYRUV��$P�+HDUW�-��6HS��H��

8��/DXIIHQEXUJHU�-&��5RELQVRQ�-*��2UDPDVLRQZX�&��)DQJ�*��5DFLDO�HWKQLF�DQG�JHQGHU�JDSV�LQ�WKH�XVH�RI�DQG�DGKHUHQFH�WR�HYLGHQFH�EDVHG�SUHYHQWLYH�WKHUDSLHV�DPRQJ�HOGHUO\�0HGLFDUH�3DUW�'�EHQH¿FLDULHV�DIWHU�DFXWH�P\RFDUGLDO�LQIDUFWLRQ��&LUFXODWLRQ��)HE��

9 Parada H Jr, Horton LA, Cherrington A, Ibarra L, Ayala GX. Correlates of medication nonadherence among Latinos with type 2 diabetes. Diabetes (GXF��-XO�$XJ��

10 Gaskin DJ, Briesacher BA, Limcangco R, Brigantti BL. Exploring racial and ethnic disparities in prescription drug spending and use among 0HGLFDUH�EHQH¿FLDULHV��$P�-�*HULDWU�3KDUPDFRWKHU��-XQ��

11��)UDQNHQ¿HOG�'/��:HL�,,��$QGHUVRQ�..��+RZHOO�%/��:DOGR�'��6HNVFHQVNL�(��3UHVFULSWLRQ�PHGLFDWLRQ�FRVW�UHODWHG�QRQ�DGKHUHQFH�DPRQJ�0HGLFDUH�&$+36�UHVSRQGHQWV��GLVSDULW\�E\�+LVSDQLF�HWKQLFLW\��-�+HDOWK�&DUH�3RRU�8QGHUVHUYHG��0D\��

12 Lanouette NM, Folsom DP, Sciolla A, Jeste DV. Psychotropic medication nonadherence among United States Latinos: a comprehensive literature UHYLHZ��3V\FKLDWU�6HUY��)HE��GRL��DSSL�SV��5HYLHZ�

13 Hu D, Juarez DT, Yeboah M, Castillo TP. Interventions to increase medication adherence in African-American and Latino populations: a literature UHYLHZ��+DZDLL�-�0HG�3XEOLF�+HDOWK��-DQ��

14 Lopez, H, Gonzalez-Barrera, A, Patten, E. “Internet Use,” Closing the Digital Divide: Latinos and Technology Adoption. Pew Research Center, Hispanic Trends. 7 March, 2013.

15 Pedersini, R, Isherwood, G, Vietri, J. “Harmonizing measurement of adherence across the 4 item and 8 item Moriskey Medication Adherence Scale using cross-sectional data from patients treated for irritable bowel syndrome.” Kantar Health, Poster presented at the ISPOR 18th Annual European Congress, Dublin, Ireland. 2-6 November, 2013.

16 HHS and U.S. Census, 2015.

&RXOG�EH�D�VLJQL¿FDQW�GLIIHUHQFH�EHWZHHQ�3XHUWR�5LFDQ�UHVSRQGHQWV�DQG�DOO�RWKHU�UHVSRQGHQWV��EXW�GLI¿FXOW�WR�GHWHUPLQH

6LJQL¿FDQW�GLIIHUHQFH


hispanic medication adherence studyholadoctor.net/pdf/white-paper/holadoctor hispanic... ·...

Documents