title: Access to Care and Diabetes Management Among Older American Indians With Type 2 Diabetes.
abstract: OBJECTIVE
  To examine the relationship between health care access and diabetes management among a geographically diverse sample of American Indians (AIs) aged 50 and older with type 2 diabetes.
  
  
  METHODS
  We examined the relationship between access to care and diabetes management, as measured by HbA1c, using 1998-1999 data from the Strong Heart Family Study. A series of bivariate and multivariate linear models examined the relationships between nine access-related variables and HbA1clevels.
  
  
  RESULTS
  In bivariate analyses, out-of-pocket costs were associated with higher HbA1clevels. No other access-related characteristics were significantly associated with diabetes management in bivariate or in multivariate models.
  
  
  CONCLUSIONS
  Access-related barriers were not associated with worse diabetes management in multivariate analyses. The study concludes with implications for clinicians working with AI populations to enhance opportunities for diabetes management.
authors.affiliation: 1 University of Michigan School of Social Work, Ann Arbor, MI, USA.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Nicklett
authors.affiliation: 2 Washington State University College of Nursing, Spokane, WA, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Omidpanah
authors.affiliation: 3 University of Washington School of Law, Seattle, WA, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Whitener
authors.affiliation: 4 MedStar Health Research Institute; Hyattsville, MD, USA; Georgetown University School of Medicine, Washington, D.C., USA.
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.affiliation: 5 University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Spero M
authors.initials: SM
authors.lastname: Manson
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D014481:United States
keywords: American Indians; access to care; diabetes; health services; rural aging