Date of Award

Winter 2010

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Qi Harry Zhang

Committee Member

Elizabeth F. Giles

Committee Member

George Maihafer


Prescription medications are essential to the treatment and management of chronic conditions (Smith et al., 2005). Lack of access can result in pain, worsening of the condition and increased risk of additional health problems. Health care expenditures in the United States were reportedly 1.7 trillion in 2003 (Smithetal.,2005) and exceeded" role="presentation" style="box-sizing: border-box; display: inline-table; line-height: 0; font-size: 16.66px; overflow-wrap: normal; word-spacing: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; margin: 0px; padding: 1px 0px; position: relative;">1.7trillionin2003(Smithetal.,2005)andexceeded1.7trillionin2003(Smithetal.,2005)andexceeded2.3 trillion in 2008 (Centers for Medicare and Medicaid Services, 2010). Prescription medication costs constitute a significant burden for patients who are uninsured and managing chronic conditions and links to the likelihood of medication non-compliance (Piette, et al., 2006; Reed, 2005; Solomon, 2005).

To enhance its chronic disease management model for uninsured patients diagnosed with chronic conditions requiring prescription regimens, a local community health center added a pharmaceutical access component to its health care delivery model.

The purpose of this research was to test the ability of the Andersen Behavioral Model of Health Services Use to model health services use among adult uninsured patients managing physician-diagnosed chronic conditions. Andersen's original Behavioral Model of Health Services Use, developed in the 1960s, suggests individual health behavior patterns are based on predisposition to care, factors that impede or enable the use of care and overall need for care (Andersen, 1968).

This research documents particularly the independent contribution of increased access to prescription medication as an enabling resource. This study employed a longitudinal, quasi-experimental design covering a period of 90 days. There existed no random assignment or random selection. This project yielded 100% follow-up (N=427). Of the 427 participants, 61.6% (n=263) participants qualified for the stop-gap medication program offered by the host community health center. Participants who were not eligible for stop-gap medications were more likely to have a telephone encounter, physician/nurse triage visit and an emergency department visit during the follow-up period than participants who were eligible for stop-gap medications. For all four clinical outcomes, the mean follow-up readings were lower than the mean baseline readings for participants who had access to stop-gap medications. The largest predictor of a positive change in outcomes was access to stop-gap prescription medications when controlling for population characteristics and health behaviors.