Title page for ETD etd-0610103-121948

Type of Document Dissertation
Author McCabe, Bhrett A.
Author's Email Address bmccab1@lsu.edu
URN etd-0610103-121948
Title Barriers to Adherence in a Free Medication Program for Low Income Individuals with Type 2 Diabetes
Degree Doctor of Philosophy (Ph.D.)
Department Psychology
Advisory Committee
Advisor Name Title
Phillip J. Brantley Committee Chair
Jolene Johnson Committee Member
Mike Hawkins Committee Member
William F. Waters Committee Member
Wm. Drew Gouvier Committee Member
Brij Mohan Dean's Representative
  • minority health promotion
  • health beliefs model
  • compliance
  • metformin
  • chronic medical conditions
Date of Defense 2003-04-30
Availability unrestricted
Diabetes self-management and treatment require significant patient involvement to maintain appropriate glucose control. Glucose control is directly related to adherence to a variety of regimens, of which medication adherence may be most important. Unfortunately, adherence to these regimens has been quite poor. Among low income patients, the strongest reason given for medication nonadherence has been the cost associated with purchasing medication. In 1999, the Louisiana State University Health Care Services Division instituted a free medication program for low income individuals with chronic illnesses, including diabetes. Despite removing this strongest barrier to adherence among low income patients, initial data from this program indicate poor adherence to the pharmacy refill program. The present study examined the association of participant reported barriers to treatment and pharmacy refill adherence in the absence of medication cost, and demonstrated a significant inverse relationship between adherence and barriers to treatment (r=-.330, p<.05). Barriers commonly endorsed included costs of purchasing the medication, endorsed by greater than 75% of the sample, despite participating in a free medication program. Other frequently endorsed barriers included difficulty remembering aspects of the medication regimen, lack of transportation or assistance from their family, and side effects of the medication. Few demographic differences emerged regarding rates of adherence or the total number of barriers endorsed, but African American participants were more likely to endorse the barrier that the medication makes their stomach upset than white participants. The utility of the pharmacy refill program was also examined, as adherence to the free medication program was significantly related to improved metabolic functioning (r=-.348, p<.01) in the sample of low income primary care patients with type 2 diabetes. The results of the current study highlight the importance of assessing barriers to medication adherence in a population of low income individuals. In addition, the results of this study demonstrate the importance of encouraging patients to adhere to their medication regimen, as it may contribute to improved health functioning and medical outcomes. Generalization of these findings, however, is limited somewhat by the low rate of consent to participate in the study and a less than optimal sample size.
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