Extent, Determinants and Consequences of Cost-Related Non-Adherence to Prescription Medications Among People With Spinal Cord Injuries in Canada

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Gupta, Shikha
Spinal Cord Injury , Cost-Related Non-Adherence , Prescription Medications , Canada , Drug Costs , Drug Insurance
The overall purpose of this doctoral thesis was to build an understanding of financial barriers faced by people with disabilities to pay for their prescription medications. The thesis was composed of four different studies that were designed and conducted logically to fulfill this objective. Study 1 was a scoping review that analyzed the type, extent, and quantity of research available on CRNA to prescription drugs in Canada. The study had three notable findings: first, between 4-36% of Canadians face CRNA to fulfill their medications; second, people between 18 and 64 years, with low income, poor health status, no insurance coverage, and high out-of-pocket cost on medications are at risk of facing CRNA; and third, CRNA to prescriptions may have an adverse effect on individuals’ health and may lead to other social consequences; however, the evidence for this is still underdeveloped. This research revealed an evidence gap that no studies are available to understand CRNA among people with disabilities. Study 2 was a theoretical paper that argued for the reconsideration of existing models on CRNA for application to people with disabilities. The study suggested an adapted model needed to examine CRNA within the context of disability. This adapted model served as a conceptual framework for study 3. Study 3 quantified the magnitude and risk factors of medication non-adherence among people with SCIs. The study revealed that the cost of prescribed medications spent by individuals with SCIs and the extent of CRNA is greater than that is reported for general Canadian households. Medication-related, disability-related, and socio-economic factors were the main influencers that determined the risk of facing CRNA among participants, parallel to what was proposed in the adapted model. Lastly, study 4 aimed to understand the processes underpinning medication cost burden through a qualitative inquiry. The study found five key strategies adopted by the participants to manage the burden of medication cost. From the overall findings of the thesis, I offer recommendations to improve financial access to medications among people with disabilities in general and people with SCIs in particular, within Canada.
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