Food Insecurity, Processes of Care, and Self‐Reported Medication Underuse in Patients with Type 2 Diabetes: Results from the California Health Interview Survey

Abstract

Objective To assess the independent association of food insecurity with processes of care and delays in filling prescriptions. Data Source 2007 California Health Interview Survey Study Design Associations of food insecurity with processes of care and delays in filling prescriptions were examined using multivariable logistic regression analyses adjusted for sociodemographic characteristics, barriers to accessing care, and health status. Data Extraction Data were analyzed from adults currently receiving treatment for type 2 diabetes and who had seen a doctor in the prior 12 months (N=3401) Principal Findings For diabetes patients currently receiving medical care, food insecurity was not associated with lower rates of performance of recommended processes of care, but was associated with delays in filling prescriptions (aOR=2.15, 95% CI 1.25, 3.71). Conclusions Food insecurity may increase delays in filling prescriptions in daily life, even though the performance of recommended processes of care in the clinic is not diminished.

Food Insecurity and Health Outcomes Among Older Adults: The Role of Cost-Related Medication Underuse

“…This study, which was restricted to adults with chronic diseases, found that people living in food-insecure households were more likely to report CRMU. Similar findings have been demonstrated from smaller studies in different parts of the country among the non-elderly (25)(26)(27)(28)(29) and among low-income older adults (30)(31)(32).…”

“…These results suggest that FI among older adults in particular, has serious Food Insecurity and Health Outcomes Among Older Adults 333 implications for compliance with prescribed medication, hence medical management of disease. Although prior studies focused on specific populations, the results are generally consistent (18,(25)(26)(27)(28)(29)42). Berkowitz and colleagues (18) found that FI was associated with CRMU among adults with chronic disease, and Seligman and associates (25) and Billimek and Sorkin (26) found that FI was associated with delays in filling prescriptions among adults with diabetes.…”

“…Although prior studies focused on specific populations, the results are generally consistent (18,(25)(26)(27)(28)(29)42). Berkowitz and colleagues (18) found that FI was associated with CRMU among adults with chronic disease, and Seligman and associates (25) and Billimek and Sorkin (26) found that FI was associated with delays in filling prescriptions among adults with diabetes. Bengle and colleagues (30) and Sattler and Lee (31) also found that FI was associated with cost-related medication nonadherence among low-income older adults in community-dwellings in Georgia.…”

Psychosocial Factors Related to Underuse of Medical Services

“…[1][2][3][4][5] There are serious and alarming consequences of the underuse of health care. For example, Farley and his colleagues 3 estimated that increasing the use of nine clinical prevention services to more optimal levels could prevent 50,000-100,000 deaths each year among adults younger than 80 years of age.…”

Barriers to care for patients with diabetes in Durham, North Carolina, why are we withholding life-sustaining medications from the patients who need them the most?

“…Far too often, when visiting homes of high-risk patients, we have found no food in the pantry and no pills in the bottles. Food insecurity has been correlated with worse diabetes control as evidenced by HbA1c levels, higher admission rates for hypoglycemia, especially at the end of the month when money is tighter, and delay in filling prescription medications [12][13][14][15]. Many of the medications prescribed for diabetic patients are generic and can be purchased for US$4 at Walmart, but that $4 co-payment can be an insurmountable barrier when one's basic living expenses are higher than one's income.…”