Browsing by Subject "Diabetes in children"
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Item Adherence to oral antidiabetic medications in the pediatric population with type 2 diabetes(2011-05) Adeyemi, Ayoade Olayemi; Rascati, Karen L.; Strassels, Scott A.; Lawson, Ken A.The present study involved the analyses of the Texas Medicaid prescription claims data. The population studied was made up of subjects between 10 and 18 years who had at least 2 prescriptions of the same oral antidiabetic (OAD) medication from January 1, 2006 through December 31, 2009. Twelve months’ data for each subject were analyzed. The main aim of the study was to describe OAD medication use patterns in the study population, assess trends in Medication Possession Ratio (MPR) and persistence in the study population and determine the relationship between age and MPR and between age and persistence while controlling for covariates. Results of the descriptive statistics, multiple and logistic regression analyses are reported. The average age (± SD) of the 3,109 eligible subjects was 14 (± 2) years; minority populations made up the majority (87%) of the population; 67% of the population were females; and 91% were on the OAD metformin. The overall mean MPR (± SD) for the population was 45% (± 27). A significant negative relationship between MPR and age was reported while controlling for covariates (p<0.0001). Among the covariates, white race and male were significantly associated with a higher MPR, holding other variables constant. When adherence was dichotomized (MPR < 80% and MPR >= 80%), logistic regression analysis also found that age was significantly and negatively related to MPR (p < 0.0001). In addition, the white race and male were again significantly related to a higher level of adherence, holding other variables constant. The overall mean days to non-persistence (± SD) was 108 days (± 86). Persistence was significantly and negatively associated with age, holding other variables constant (p < 0.0001). Among the covariates, white race was significantly related to longer persistence. In conclusion, adherence and persistence are generally low in the study population. Age, gender and race were significantly associated with adherence. Being younger, male, and white were significantly associated with a higher level of adherence, while being younger and white were significantly associated with longer persistence. Healthcare providers therefore need to intensify efforts to improve adherence in pediatric patients especially those at the brink of adulthood.Item Rural and Hispanic disparities in parents' evaluations of their children's care(Texas Tech University, 2003-08) Brannon-Goedeke, Angelique AThe primary purpose of this study was to assess whether disparities exist between Hispanic and non-Hispanic white parents' evaluations of their children's access to health care and the odds of visiting a physician. The secondary purpose was to evaluate whether there are rural/urban disparities in parents' reports of their children's care and whether rural residence is associated with the odds of visiting a physician. Reports of children's health care access were measured with items from the U.S. Agency for Healthcare Research and Quality's Consumer Assessment of Health Plans Study (CAHPS) instrument. A telephone survey of over 5,000 adults age 18 years and older who had at least one child between the ages of 3 and 18 and resided in the 109 counties comprising West Texas was conducted to assess various ratings and reports of health status and health care access for children. Access-related items in the Childhood Diabetes Survey include parents' reports of their ability to receive appointments for routine/regular health care for their child when needed, ability to receive immediate care for a child's illness or injury when needed, receive advice or help needed over the phone, not having to wait more than 15 minutes past the appointment time in the physician's office, and whether the child visited a physician in the past 12 months. Andersen and Aday's behavioral model of health services was used to determine how predisposing, enabling, and need factors are associated with parents' evaluations of specific aspects of their children's access to care and the likelihood that their children made a physician visit in the 12 months preceding the survey. The first hypothesis was that when predisposing, enabling and need factors are controlled for, Hispanics have lower evaluations of their children's access to health care, including getting appointments for routine care when needed, getting an appointment for immediate care when needed, getting the medical advice or help needed, getting care in a timely manner, and their children have a lower odds of visiting a physician than their non-Hispanic white counterparts. The second hypothesis was that when predisposing, enabling, and need factors are controlled for, parents living in rural areas have worse evaluations of their children's access to health care, including getting appointments for routine care when needed, getting appointments for immediate care when needed, getting the medical advice or help needed over the phone, getting care in a timely manner, and their children have a lower odds of visiting a physician than their urban counterparts. Hispanic parents were significantly less likely than non-Hispanic whites to obtain an appointment for their child for regular/routine care, obtain an appointment for immediate care for a child's illness or injury, obtain needed advice over the phone, to report that their child 'never' had an excessive wait time when they did visit a physician, and to have made a physician visit in the past 12 months. While Hispanic parents had worse evaluations of all aspects of their children's access to care, rural residence was only associated with parents' reports of being able to obtain an appointment for immediate care for a child's illness or injury and of not having excessive wait times in the physician's office. However, the association was in the opposite direction than originally hypothesized. Urban residents were significantly less likely to report that their child 'never' had an excessive wait time and significantly less likely to report that their child always received immediate care for an illness or injury. This thesis serves as an example of how a population-based study of parents' reports of their children's access to care can help policy makers evaluate how to improve access for vulnerable subpopulations. For example, Hispanic residents reported greater difficulty obtaining an appointment for regular/routine care for their children than did their non-Hispanic white counterparts, even when controlling for predisposing and enabling factors. Moreover, urban residents reported greater instances of their children having to wait more than 15 minutes past the appointment time than did their rural counterparts. Additional research is needed to determine how access to health care services could be made more attainable to those subgroups reporting problems.