Evidence mapPaperPMID 41184704Full record

ArticleJournal of general internal medicine2026

A Patient-Informed Framework of Financial Strain Among Adults with Multimorbidity.

Caroline E Sloan, Michael A Lourie, C Barrett Bowling, Michael Pignone, Courtney H Van Houtven, Cara L McDermott

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Article in Journal of general internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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6 authors.

Caroline E SloanDivision of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA. caroline.sloan@duke.edu.ORCID 0000-0003-1611-3846
Michael A LourieDivision of Hospital Medicine, Northwestern University School of Medicine, Chicago, IL, USA.
C Barrett BowlingDepartment of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
Michael PignoneDivision of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
Courtney H Van HoutvenDepartment of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
Cara L McDermottDepartment of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.

Funding

Advancing Geriatrics Infrastructure and Network Growth (AGING) InitiativeR33AG057806 · OREGON HEALTH & SCIENCE UNIVERSITY · 2025 to 2025
$817k
Improving medication adherence and disease control for patients with multimorbidity: the role of price transparency toolsK23AG076889 · NIA · DUKE UNIVERSITY · 2024 to 2025
$360k
Reducing Polypharmacy and Fall Risk for Multi-Morbid Adults with Chronic Obstructive Pulmonary DiseaseK23HL159239 · DUKE UNIVERSITY · 2025 to 2025
$180k
National Heart and Lung Institute K23HL159239NHLBI NIH HHS K23 HL159239NIA NIH HHS K23 AG076889NIA NIH HHS K23AG076889NIA NIH HHS R33 AG057806NIA NIH HHS R33AG057806
6 · The paper itself

Abstract

backgroundOver one-quarter of adults have multimorbidity. Patients with multimorbidity are more likely to struggle to afford their care than patients without multimorbidity, but their experiences with financial strain have not been fully described.

objectiveWe qualitatively explored the lived experiences of adults with multimorbidity to develop a framework describing financial strain in this patient population.

designUsing semi-structured interviews, we asked participants to describe scenarios causing financial strain, any exacerbating or alleviating factors, and emotional/behavioral responses.

participantsAdults who had ≥ 2 of 5 pre-defined chronic conditions (heart failure, coronary artery disease, diabetes, chronic obstructive pulmonary disease, hypertension), took ≥ 5 medications, and received care at a safety-net primary care clinic. MEASUREMENTS: We analyzed transcripts using rapid qualitative analysis.

resultsAmong 13 participants, age was 42-68 years, 7 were female, 7 had self-reported Black race, and 9 were enrolled in Medicaid. On average, participants had 3/5 pre-defined chronic conditions and were prescribed 10 medications. Financial strain was driven by complex cycles of chronic disease stability and exacerbations, high medical costs (e.g., medications), non-medical costs (e.g., transportation), and low financial reserve (e.g., income loss due to hospitalizations). Participants felt they had to prioritize certain health conditions over others due to cost. Protective factors included caregiver support, financial assistance programs, and assistance from community organizations. Responses to financial strain included rationing care and borrowing money, which negatively impacted disease control and credit scores. LIMITATIONS: All interviews were conducted at a single site.

conclusionFinancial strain in multimorbidity stems from a complex interplay between individual, health system, and community factors, some of which may not be ascertained in routine interactions with primary care providers.

Indexed as

Financial StressMultimorbidityAdultAgedChronic DiseaseFemaleHumansMaleMiddle AgedQualitative ResearchUnited Statesfinancial strainfinancial toxicitymultimorbiditymultiple chronic conditions

Identifiers

PMID41184704
PMCPMC12960873

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