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Medication adherence in a nurse practitioner managed clinic for indigent patients

Alton, Suzanne DNP, FNP-BC1,a; March, Alice L. PhD, RN, FNP, CNE1,a; Mallary, Laura MA2,b; Fiandt, Kathryn PhD, RN, FNP-BC, FAANP, FAAN2,c

Journal of the American Association of Nurse Practitioners: August 2015 - Volume 27 - Issue 8 - p 433–440
doi: 10.1002/2327-6924.12211

Purpose: Little is published in the literature about medication adherence rates among patients who are medically indigent and patients receiving primary care from nurse practitioners (NPs). This project examined adherence rates and barriers to adherence among patients at an NP-managed health clinic (NPMC).

Data sources: The setting for this research was an NPMC for uninsured and low-income patients. A cross-sectional convenience sample of patients (n = 119) completed surveys eliciting demographic information, self-report of medication adherence, health literacy, and barriers to adherence.

Conclusions: Analysis of subjects demonstrated a vulnerable population, yet the mean adherence rate was surprisingly high (77%), compared to the rate usually cited in published literature. The best predictive model differentiating patients with high adherence from those with low adherence combined the total number of reported barriers, health literacy, and employment status. The barriers most frequently cited by subjects were difficulty paying for medications, and difficulty reading and understanding written prescription labels, which was particularly prevalent among Spanish-speaking patients.

Implications for practice: Clinic efforts to improve patient access to affordable medications may have contributed to subjects’ high rates of adherence. These efforts included helping patients with filling out prescription assistance program paperwork, prescribing generic medications, providing samples, and providing effective patient education.

1 The University of Alabama, Tuscaloosa, Alabama,

2 University of Texas Medical Branch, Galveston, Texas,

Received 16 January 2014; Accepted 24 July 2014

Correspondence Suzanne Alton, DNP, FNP-BC, School of Nursing, University of Texas Medical Branch, Galveston, TX 77555-1029. Tel: 409-599-1695; Fax: 409-772-8270; E-mail: or

a(Associate Professor)



© 2015 American Association of Nurse Practitioners
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