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Author Notes:

Address correspondence and requests for reprints to Dr. Gazmararian: Emory Center on Health Outcomes and Quality, Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322; Email: jagazma@sph.emory.edu


Research Funding:

This research was supported by an unrestricted grant from Pfizer and from a grant from the Aetna Foundation and the Quality Care Research Fund.

Dr. Kripalani receives support from a K23 Mentored Patient-Oriented Research Career Development Award (1 K23 HL077597). While conducting the present research, he was previously supported by the Emory Mentored Clinical Research Scholars Program (NIH/NCRR K12 RR017643).


  • elderly
  • health literacy
  • adherence

Factors Associated with Medication Refill Adherence in Cardiovascular-related Diseases: A Focus on Health Literacy


Journal Title:

Journal of General Internal Medicine


Volume 21, Number 12


, Pages 1215-1221

Type of Work:

Article | Post-print: After Peer Review


BACKGROUND The factors influencing medication adherence have not been fully elucidated. Inadequate health literacy skills may impair comprehension of medical care instructions, and thereby reduce medication adherence. OBJECTIVES To examine the relationship between health literacy and medication refill adherence among Medicare managed care enrollees with cardiovascular-related conditions. RESEARCH DESIGN Prospective cohort study. SUBJECTS New Medicare enrollees from 4 managed care plans who completed an in-person survey and were identified through administrative data as having coronary heart disease, hypertension, diabetes mellitus, and/or hyperlipidemia (n=1,549). MEASURES Health literacy was determined using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). Prospective administrative data were used to calculate the cumulative medication gap (CMG), a valid measure of medication refill adherence, over a 1-year period. Low adherence was defined as CMG≥20%. RESULTS Overall, 40% of the enrollees had low refill adherence. Bivariate analyses indicated that health literacy, race/ethnicity, education, and regimen complexity were each related to medication refill adherence (P<.05). In unadjusted analysis, those with inadequate health literacy skills had increased odds (odds ratio [OR]=1.37, 95% confidence interval [CI]: 1.08 to 1.74) of low refill adherence compared with those with adequate health literacy skills. However, the OR for inadequate health literacy and low refill adherence was not statistically significant in multivariate analyses (OR=1.23, 95% CI: 0.92 to 1.64). CONCLUSIONS The present study suggests, but did not conclusively demonstrate, that low health literacy predicts poor refill adherence. Given the prevalence of both conditions, future research should continue to examine this important potential association.

Copyright information:

© 2006 by the Society of General Internal Medicine. All rights reserved

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