Diabetes Mellitus Medication Assistance Program: Relationship of Effectiveness to Adherence

Statistical Analysis, Louisiana State University Health Care Services Division, Baton Rouge, LA 70821, USA.
Journal of Health Care for the Poor and Underserved (Impact Factor: 1.1). 09/2008; 19(3):677-86. DOI: 10.1353/hpu.0.0062
Source: PubMed


This retrospective study examines the effect of a medication assistance program (MAP) on HbA1c levels in an uninsured, low-income, type 2 diabetes population. It also examines the degree to which improvement in HbA1c level varied with adherence to medication regimens among those patients using the MAP. The MAP was found to have a mean effect of -0.60% on HbA1c levels. However, MAP users differed in how strictly they adhered to medication regimens, as measured by number of refill opportunities taken. The MAP's effect on HbA1c varied monotonically with adherence level, with greater adherence leading to greater HbA1c improvement. Never refilling the prescription (complete nonadherence) led to no change in HbA1c, while complete adherence led to an estimated -0.88% improvement in HbA1c. Further study is needed to investigate factors related to non-adherence within medication assistance programs and the effect of such programs on other patient outcomes.

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    ABSTRACT: Disease management has become an important tool for improving population patient outcomes. The Louisiana State University Health Care Services Division (HCSD) has used this tool to provide care to a largely uninsured population for approximately 10 years. Eight programs currently exist within the HCSD focusing on diabetes, asthma, congestive heart failure, HIV, cancer screening, smoking cessation, chronic kidney disease, and diet, exercise, and weight control. These programs operate at hospital and clinic sites located in 8 population centers throughout southern Louisiana. The programs are structured to be managed at the system level with a clinical expert for each area guiding the scope of the program and defining new goals. Care largely adheres to evidence-based guidelines set forth by professional organizations. To monitor quality of care, indicators are defined within each area and benchmarked to achieve the most effective measures in our population. For example, hemoglobin A1c levels have shown improvements with nearly 54% of the population <7.0%. To support these management efforts, HCSD utilizes an electronic data repository that allows physicians to track patient labs and other tests as well as reminders. To ensure appropriate treatment, patients are able to enroll in the Medication Assistance program. This largely improves adherence to medications for those patients unable to afford them otherwise.
    Full-text · Article · Jun 2008 · Disease management: DM
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    ABSTRACT: The Louisiana State University Health Care Services Division system assessed the effectiveness of implementing a multisite disease management program targeting diabetes mellitus in an indigent patient population. A population-based disease management program centered on evidence-based clinical care guidelines was applied from the system level. Specific clinic modifications and models were used, as well as ancillary services such as medication assistance and equipment subsidies. Marked improvement in process goals led to improved clinical outcomes. From 2001 to 2008, the percentage of patients with a hemoglobin A1c < 7.0 increased from 45% to 55% on the system level, with some sites experiencing a more dramatic shift. Results were similar across sites, which included both small provider groups and academic health centers. In order to achieve these results, the clinical environment changed to promote those evidence-based interventions. Even in complex environments such as academic health centers with several provider levels, or those environments with limited care resources, disease management programs can be successfully implemented and achieve statistically significant results.
    No preview · Article · Dec 2010 · Population Health Management
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    ABSTRACT: Objective: This study was intended to evaluate the impact of a province-wide Diabetes Assistance Program (financial and self-management support) in a representative sample of individuals with diabetes and unmet financial needs. The impact of the program was evaluated on individuals managed with insulin or oral antihyperglycemic agents alone and also on individuals with good, suboptimal or poor diabetes control. METHODS: Participants were recruited from the entire population of individuals approved for the Nova Scotia Diabetes Assistance Program into this pre/post cohort study of people with type 1 or 2 diabetes. Participants were recruited by letter, and data were obtained via phone interview. Participants were assessed with regard to glycemic control, self-care and quality of life. RESULTS: The Diabetes Assistance Program was unable to show a strong net benefit for the entire study sample, but there were significant findings when initial degree of glycemic control was considered, and to a lesser extent, method of control. The strongest positive impact was for those patients with poor control (glycated hemoglobin [A1C] >8.5%), who had significant improvements in glycemic control (absolute reduction in A1C of 0.9%), self-care and quality of life were observed. Minor positive effects were also demonstrated for those with suboptimal control. Those with good control demonstrated an increase in A1C. CONCLUSION: This study demonstrates the value of providing support for those with poor glycemic control. Interestingly, those with good control did not benefit from support. These data suggest that efforts to support individuals with diabetes should be directed at those most likely to benefit.
    No preview · Article · Mar 2011 · Canadian Journal of Diabetes
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