Continuous access to medication and health outcomes in uninsured adults with type 2 diabetes

Abstract

Background and purpose Achievement of recommended targets for HbA1c, low‐density lipoproteins (LDLs), and blood pressure (BP) improves outcomes in adults with diabetes. To meet targets, access to an affordable and consistent supply of medication is necessary, which can be challenging for the medically underserved. The Social Determinants of Health (SDOH) framework guided variable selection in this study, which explored the relationship between continuous access to medication and HbA1c, LDL, and BP in adults with type 2 diabetes who are uninsured and of low socioeconomic status. Methods This study was conducted using archived medical record data and a convenience sample of adults (n = 65) who received health care on a mobile health van and medications from a pharmaceutical procurement program. Pre–post data were analyzed using dependent t‐tests. Conclusions Continuous access to medication was related to improved HbA1c (p = .003), LDL (p = .004), and systolic BP (p = .025). Access to a consistent source of medications for chronic disease is related to improved health outcomes. Practice implications Knowledge was gained about the effect of improved access, nontraditional healthcare delivery systems, and improved outcomes related to collaboration among community partners. Interventions aimed at the wider SDOH may reduce disparities of the medically underserved.

Impact of Geographic Socioeconomic Disadvantage on Minor Amputation Outcomes in Patients With Diabetes

“…Certain subgroup analyses in our study may also be somewhat underpowered. For example, the association of worsened health outcomes among uninsured diabetics has been well described 35,36 ; however, we demonstrate nonsignificant results among this subgroup, which only composed 2.93% of our population. Finally, the unique payer system in the state of Maryland may impact our results.…”

Does General Health Differ by Healthcare Access in Diabetic Females Ages 30 –50?

“…Across states, the majority of diabetic females reported good or better general health, having healthcare coverage, and not having cost precede doctor visits. The results of adjusted analysis indicated that general health in this population was not related to healthcare coverage, which differs from previous studies that have found that having healthcare coverage improved general health outcomes [9,12]. This discrepancy may be related to different target populations or different measures for healthcare coverage as ours did not include specific types of plans, such as Medicare, Medicaid, other public insurance, private insurance, or high deductible plans [15,17].…”

“…Theoretically, access to healthcare would make required medical care more attainable; however, even in countries with universal health insurance coverage, not every patient utilizes the medical care available [6]. Overall, the avoidance of complications and negative outcomes related to diabetes requires access to comprehensive and integrated care [7,8], including medication access [9] and regular doctor visits [10].…”

Socio-economic Determinants of Bone Health from Past to Present

“…The SDoH model clearly demonstrated that a series of correlated factors that often arise beyond one's control determine health outcomes. Support for SDoH has subsequently been shown, for example, using links between low SES uninsured individuals and type 2 diabetes [33], mental health and addiction and ethnic disparities [34], as well as social risk based upon factors such as education and income related to frailty that includes chronic illness, physical and emotional health [35]. To better understand the mechanisms behind these bio-social relationships, life course approaches to studying health, disease, and mortality from the foetal to adult stages resulted in the Developmental Origins of Health and Disease (DOHaD) paradigm, also known as the Barker hypothesis [36][37][38][39][40].…”