To the Editor:
We thank Drs. Ravindran and Jadhav for their interest1 in our article describing cost-related medication nonadherence in older patients with rheumatoid arthritis cared for in the United States2. We agree with their comments that adherence to medications is a complex behavior that is influenced by patient factors3,4. Those authors wondered whether patient education may have influenced the adherence rates we observed in our study rather than costs, similar to what they found in their prospective cohort study in which patients receiving education had higher adherence than the control group (98% vs 83%). This is certainly possible, although we have no data in our study for examining the role of patient education on medication adherence. Of note, the study populations were quite different between the 2 studies. Ours focused on a national sample of US older patients with a variety of drug payment coverage arrangements, and the majority of the patients were not working. In contrast, the sample in the study by Drs. Ravindran and Jadhav was younger, with most being homemakers or workers with self-funded healthcare, and living in India3.
