Date of Award

Fall 11-4-2016

Document Type


Degree Name

Doctor of Nursing Practice (DNP)

First Advisor

Carol J. Sapp, RN, Ph.D., CNE

Second Advisor

Sheryl Winn, DNP, MSN, APRN, ANP-BC

Third Advisor

Melinda Hartley, DNP, MBA, RN, NE-BC



Purpose: The purpose of this project was to determine if not having a prescription patient assistance program (PAP) has an effect on HgbA1c levels in the uninsured with diabetes mellitus type 2 (DM2) enrolled at a community-based free clinic.

Background: If the uninsured patient has no access to a prescription PAP adherence to an evidence-based-practice (EBP) medication regimen could be compromised and result in high glucose levels leading to DM2 sequelae and a fiscal impact on the health care system.

Methods: Subjects, n = 14, were uninsured DM2 patients currently enrolled in a free clinic, ages 18 – 64 years. Instrumentation was a custom data extraction checklist approved by three academic and nurse executive experts. Descriptive, retrospective analysis of secondary data was manually extracted from paper records. The Statistical Package for the Social Sciences (SPSS) was used for analysis with Chi-square cross-tabulation test, a Phi score, and a Fisher’s Exact test.

Results: No relationship was found between HgbA1c levels and prescription PAP. Even though no relationship was found in the analysis of the small sample several significant secondary findings resulted in quality improvement initiatives: establishment of a DM2 clinical pathway and a DM2 Patient Registry.

Implications: The project led to the creation of a clinical pathway in the form of an algorithm to meet American Diabetes Association (ADA) standards of DM2 care. The pathway was augmented by creation and implementation of a DM2 Patient Registry. Access to a prescription PAP was improved with a tool for increased awareness of possible gaps in EBP treatment modalities such as HgbA1c monitoring according to ADA standards.

Keywords: uninsured health care, glycemic control, diabetes registry, diabetes management, prescription patient assistance programs

Included in

Nursing Commons