Self-reported Neighborhood Safety and Nonadherence to Treatment Regimens Among Patients with Type 2 Diabetes

• Published in: Journal of general internal medicine : JGIM Vol. 27; no. 3; pp. 292 - 296
• Main Authors: Billimek, John, Sorkin, Dara H.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.03.2012; Springer; Springer Nature B.V
• Subjects: Biological and medical sciences; California; Compliance; Cross-Sectional Studies; Diabetes; Diabetes Mellitus, Type 2 - therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General aspects; Health behavior; Health Status; Humans; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neighborhoods; Original Research; Patient Compliance - statistics & numerical data; Patient safety; Patient Safety - statistics & numerical data; Quality of care; Residence Characteristics; Self Care; Surveys and Questionnaires; California; neighborhood safety; adherence to treatment regimens; diabetes; Endocrinopathy; Type 2 diabetes; Human; Social influence; Compliance; Self evaluation; Toxicity; Metabolic diseases; Patient; Residential neighborhoods; Medicine; Treatment; Safety; Therapeutic protocol
• DOI: 10.1007/s11606-011-1882-7
• ISSN: 0884-8734

BACKGROUND Few studies have explored the association between neighborhood characteristics and adherence to diabetes self-management behaviors, and none have examined the influence of neighborhood safety on adherence to treatment regimens among patients with diabetes. OBJECTIVE To assess whether neighborhood safety is associated with self-reports of technical quality of care and with nonadherence to diabetes treatment regimens. DESIGN A cross-sectional analysis of a population-based sample of California adults responding to the 2007 California Health Interview Survey. Multivariable logistic regression models were used to examine the association of self-reported neighborhood safety with technical quality of care and treatment nonadherence, adjusted for sociodemographic characteristics, barriers to access to care, and health status. PARTICIPANTS Adults with type 2 diabetes currently receiving medical treatment. MAIN MEASURES Patient-reported neighborhood safety, performance of recommended processes of care by provider, treatment nonadherence (patient delays in filling prescriptions and obtaining needed medical care). KEY RESULTS Self-reported neighborhood safety was not associated with process measures of technical quality of care, but was associated with treatment nonadherence. Specifically, compared to those who report living in a safe neighborhood, a higher proportion of patients living in unsafe neighborhoods reported delays in filling a prescription for any reason (21.9% vs. 12.8%, aOR = 1.69, 95%CI 1.19, 2.40) and delays in filling a prescription due to cost (12.2% vs. 6.8%, aOR = 1.63, 95%CI 1.02, 2.62). CONCLUSIONS Contextual factors, such as neighborhood safety, may contribute to treatment nonadherence in daily life, even when the technical quality of care delivered in the clinic is not diminished.