Dissertation/Thesis Abstract

Continuous access to medication and health outcomes in uninsured adults with type 2 diabetes
by Toulouse, Cheryl Dillard, Ph.D., George Mason University, 2012, 143; 3504127
Abstract (Summary)

Background and Purpose: Achieving targets for HgbA1c, low density lipids (LDL), and blood pressure (BP) can improve outcomes in adults with diabetes. To meet targets, access to affordable and consistent medication is necessary. The Social Determinants of Health framework guided variable selection in this study that explored the relationship between continuous access to medication (CAM) and HgbA1c, LDL, BP, hospitalizations (HSPs), and emergency department visits (EDVs) in adults with type 2 diabetes who are uninsured and of low socioeconomic status.

Hypothesis: CAM is related to improved HgbA1c, LDL, and BP, and reduced HSPs and EDVs.

Methods: This within-subjects study was conducted in two steps using a sample that received healthcare on a mobile van and medications from a pharmaceutical program.

Step 1: Pre-Post (N = 65) exploratory analysis using Dependent t-Tests and McNemar's tests.

Step 2: Time-Series (N = 17) quasi-experimental analysis using RM-ANOVA.

Pre-Post Results: CAM was related to improved HgbA1c (p = .003), LDL (p = .004), and systolic BP (p = .025). Time-Series

Results: CAM was related to improved HgbA1c (p = .011) with a significant reduction in mean HgbA1c (-1.14%) from preintervention to postintervention (p = .014).

Conclusions: Access to a consistent and reliable source of medication is essential to improving outcomes in adults with diabetes. In addition to providing excellent care, healthcare providers must foster opportunities to improve access to medication.

Indexing (document details)
Advisor: Milligan, Renee
Commitee: Kodadek, Marie, Kreps, Gary
School: George Mason University
Department: Nursing
School Location: United States -- Virginia
Source: DAI-B 73/08(E), Dissertation Abstracts International
Subjects: Nursing, Pharmacy sciences, Public health
Keywords: Access to care, Access to medicine, Diabetes, Helath insurance, Safety net clinic, Type 2 diabetes, Uninsured
Publication Number: 3504127
ISBN: 978-1-267-28085-5
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