Are your patients being forced to choose between food and medications?

If your chronically ill patients are having trouble affording the medications you prescribe for them, they may be experiencing food insecurity, according to a new study.

Researchers looked at data on about 10,000 adults reporting chronic illness taken from National Health Interview Survey. Within that sample, 23.4% reported experiencing cost-related medication underuse-taking less medication than prescribed, or none at all, due to costs, and 18.8% reported food insecurity-defined as “limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways” during the previous 12 months. Eleven percent reported experiencing both.

Niteesh Choudhry, MD, PhD, an associate professor in the department of medicine at Harvard Medical School in Boston, Massachusetts, and one of the study’s authors, told the New York Times that “[doctors] should be asking patients about an inability to get good food or medications every single time we see them, especially when we encounter patients who have poorly controlled chronic conditions.”

            Looking at specific subgroups, the study found that:

• Participants reporting both cost-related medication underuse and food insecurity were more likely to be Hispanic, non-Hispanic black, and have more chronic medical conditions than were patients reporting neither.

• Those experiencing neither cost-related medication underuse nor food insecurity were white, older, and had higher incomes than those in other groups.

• Hispanic and non-Hispanic black participants were less likely to report cost-related medication underuse, but more likely to experience food insecurity.

• Those not experiencing food insecurity but not meeting medication needs were more likely to have dependent children in the house, to lack insurance or have insurance that didn’t include drug coverage, and to have more chronic medical conditions.

“The high overall prevalence of food insecurity and cost-related medication underuse highlights how difficult successful chronic disease management in the current social environment is,” the authors write. “Because of these findings, assessing for both household food insecurity and cost-related medication underuse…may be warranted.”

Results of the study appear in the April, 2014 issue of The American Journal of Medicine.