Unmet prescription medication need in U.S. children
Sandhya Mehta, BPharm, MS; Saurabh Nagar, BPharm, MS; Rajender Aparasu, MPharm, PhD
J Am Pharm Assoc (2003) 2009;49:769-776. doi:10.1331/JAPhA.2009.08170


Objective  To examine the nature and extent of unmet prescription medication need (UPMN) in children and its predictors using the 2003 National Survey of Children's Health (NSCH).

Design  Retrospective cross-sectional survey.

Setting  United States in 2003–2004.

Participants  Parents or guardians who knew most about child's (<18 years of age) health and health care and reported about their children's prescription medication use.

intervention  NSCH—a population-based telephone survey—based on complex probability sampling design.

Main outcome measures  Nature and extent of UPMN in children and predictors of UPMN for any reason and as a result of cost, health plan problems, and lack of insurance within the conceptual framework of the Andersen behavioral model.

Results  According to NSCH, 0.54 million (95% CI 0.46–0.62) or 1.23% (1.05–1.41%) of children experienced UPMN. The highest prevalence of UPMN was seen among blacks (2.3%), families with income less than 200% of federal poverty level (2.4%), and those having good, fair, or poor perceived health status (3.2%). A high prevalence of UPMN was also found in children with gained (5.3%), lost (3.7%), or no insurance (6.4%). Among children with UPMN, 35.39% (28.56–42.23%) did not receive medications because of cost, 26.51% (20.28–32.74%) because of health plan problems, and 40.73% (33.21–48.24%) because of lack of insurance. Multivariate logistic regression analysis revealed that predisposing (race), enabling (poverty and insurance), and need (perceived health status and depression) factors were significantly associated with UPMN for any reason. Factors significantly associated with UPMN due to cost included enabling (insurance) and need (attention deficit hyperactivity disorder and asthma) factors. The predictors of UPMN resulting from health plan problems included predisposing (race) and enabling (insurance) factors, whereas UPMN caused by lack of insurance was only associated with an enabling factor (age).

Conclusion  More than 0.5 million children in the United States experienced UPMN, mainly as a result of cost, health plan problems, or lack of insurance. The study findings suggest that a need exists for addressing racial disparities and continuity of coverage issues in children to improve access to needed prescription medications.

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