Optimizing Pediatric Care: Bridging Gaps and Addressing Disparities for Children with Disabilities or Medical Complexities Through Medication Therapy Management (MTM)

Suwanee, GA

INTRODUCTION

Children with disabilities and medical complexity require complex medication regimens that are challenging for caregivers when managing medication. We conducted a secondary meta-analysis using data from the National Health Interview Survey (NHIS) to explore medication adherence disparities based on caregivers’ socioeconomic status. Medication Therapy Management (MTM) and similar services have been shown to improve treatment adherence. We aim to investigate the utilization of MTM services among underprivileged communities by developing a structured survey for the target population and aim to examine whether caregivers’ socioeconomic status (SES) impacts medication adherence within our study cohort. Our ultimate goal is to improve the welfare of these medically complex patients by optimizing medication regimens and care processes.

METHODS

Data were selected from the NHIS for the years 2009 through 2018. The sample consisted of children chosen from the National Health Interview Survey Child Core, where the National Center for Health Statistics (NCHS) collects health information from a randomly selected child. Children’s caregivers were categorized based on our inclusion criteria. Among all children in the core, our study population comprised children aged 5-17 years with medical complexity or disability on medication (MCDM). Poor medication adherence was coded as 1 if a caregiver reported their child not receiving prescription medicine due to affordability or if the caregiver lacked healthcare resources when ill or in need of health advice. Caregiver socioeconomic status (SES) was assessed using the poverty income ratio (PIR), which was categorized into three groups: less than 1.00, 1.00-1.99, and 2.00 or above. PIR <1.00, defined as below the federal poverty level, and PIR between 1.00 and 1.99 were considered near the poverty line. We performed multivariate logistic regression analyses to examine the relationship between caregiver poverty and our outcome. Predicted prevalence was calculated using coefficients from the regression models to demonstrate changes in disparities in poor medication adherence by caregiver socioeconomic status.

RESULTS

The percentage of children with poor medication adherence with MCDM was 9.7% in 2009-2010, which later reduced to about 6%. The percentage of caregivers with a poverty income ratio of less than 1.00 accounted for 22.2% to 27.1% between 2009-2010 and 2015-2016 but dropped to 17.9% in 2017-2018. The multivariate regression model indicates a strong association between the caregiver’s poverty-income ratio, education, race/ethnicity, and the outcome, adjusting for other covariates of interest. There were significant interactive effects between socioeconomic factors and survey periods. Results suggest that observed disparities in caregivers' poverty status, education, and race/ethnicity largely persisted between 2009-2018.

DISCUSSION

Current analysis reveals persistent disparities in medication adherence among the target population over the past decade. Implementing MTMs has strong potential to diminish the existing gaps in medication adherence among at-risk children. By providing structured support and addressing the unique needs of vulnerable populations, MTM can contribute to fostering health equity in medication management. A survey will be conducted to identify the need for MTM in children with MCDM and presented on PCOM Research Day.