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Abstract Background Non-communicable diseases (NCDs) represent the largest, and fastest growing, burden of disease in India. This study aimed to quantify levels of diagnosis, treatment, and control among hypertensive and diabetic patients, and to describe demand- and supply-side barriers to hypertension and diabetes diagnosis and care in two Indian...
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Background:
Within its reform efforts, the Government of Tajikistan is embracing the essential role of primary health care (PHC) in decreasing out of pocket (OOP) expenditures and increasing equity in access to health services. In the light of the increasing burden of disease relating to chronic conditions, we investigated OOP expenditures of pati...
Citations
... Additionally, Primary Health Centers (PHC) fosters community involvement in NCD prevention and control, ensuring equitable NCD care access (12). However, in India, health systems were initially designed to address acute communicable diseases and maternal and child health (13) but now grapple with the challenge of delivering care for chronic conditions (14,15). The primary care system for NCDs remains weak with underfunding, fragmented service delivery, and poorly functioning referral systems and faces significant resource constraints, including limited health workforce, medicine, supplies, and infrastructure (16)(17)(18)(19). ...
Background
Diabetes and hypertension are leading public health problems, particularly affecting low- and middle-income countries, with considerable variations in the care continuum between different age, socio-economic, and rural and urban groups. In this qualitative study, examining the factors affecting access to healthcare in Kerala, we aim to explore the healthcare-seeking pathways of people living with diabetes and hypertension.
Methods
We conducted 20 semi-structured interviews and one focus group discussion (FGD) on a purposive sample of people living with diabetes and hypertension. Participants were recruited at four primary care facilities in Malappuram district of Kerala. Interviews were transcribed and analyzed deductively and inductively using thematic analysis underpinned by Levesque et al.’s framework.
Results
The patient journey in managing diabetes and hypertension is complex, involving multiple entry and exit points within the healthcare system. Patients did not perceive Primary Health Centres (PHCs) as their initial points of access to healthcare, despite recognizing their value for specific services. Numerous social, cultural, economic, and health system determinants underpinned access to healthcare. These included limited patient knowledge of their condition, self-medication practices, lack of trust/support, high out-of-pocket expenditure, unavailability of medicines, physical distance to health facilities, and attitude of healthcare providers.
Conclusion
The study underscores the need to improve access to timely diagnosis, treatment, and ongoing care for diabetes and hypertension at the lower level of the healthcare system. Currently, primary healthcare services do not align with the “felt needs” of the community. Practical recommendations to address the social, cultural, economic, and health system determinants include enabling and empowering people with diabetes and hypertension and their families to engage in self-management, improving existing health information systems, ensuring the availability of diagnostics and first-line drug therapy for diabetes and hypertension, and encouraging the use of single-pill combination (SPC) medications to reduce pill burden. Ensuring equitable access to drugs may improve hypertension and diabetes control in most disadvantaged groups. Furthermore, a more comprehensive approach to healthcare policy that recognizes the interconnectedness of non-communicable diseases (NCDs) and their social determinants is essential.
... However, NCD medicines are unavailable in many countries 9 . A study by Gabert et al. 53 showed that drug stockouts in the public health system were a major barrier to NCD management, forcing patients to go to private facilities. A study by Elias MA et al. 8 showed that more than 90% of study participants depend on private healthcare facilities for NCD medicines, primarily due to the poor availability of medicines at the PHCs. ...
... The present study shows that metformin is available in 66.7% of the primary health centers, whereas the availability, according to other studies, ranges from 43.5% to 100% 8,43,47,48,53 . 8,43,47,48,53 . ...
... The present study shows that metformin is available in 66.7% of the primary health centers, whereas the availability, according to other studies, ranges from 43.5% to 100% 8,43,47,48,53 . 8,43,47,48,53 . These findings reemphasize that the availability of medicines used to manage NCDs at the primary healthcare level varies greatly across the country, and essential steps should be taken to address this discrepancy. ...
... 23 If we add the slowdown in health interventions to the situation described above as a result of the COVID-19 pandemic, all this raises challenges to the health system, where the approach to arterial hypertension and other chronic noncommunicable diseases becomes a sentinel indicator from the perspective of public health and the management of health services, becoming an expression of the good or bad that might result from the control strategies applied by the health system. 24 Even though several factors that contribute to nonadherence to antihypertensive treatment have been postulated, [25][26][27] it is important to develop studies to determine the influence of the determinants of access to health services on adherence to treatment, in order to prevent complications of the disease, in addition to having an impact on improving the Peruvian health system. Therefore, the aim of the present study was to determine the influence of access to health services on adherence to antihypertensive treatment during the COVID-19 pandemic. ...
... However, this is not consistent with what was found in this study, because although 82.99% of patients had their blood pressure checked at the time of consultation, it was not found that receiving such control was significantly associated with adherence (p=0.168). It also differs from what was reported by Gabert et al., 27 in that study, which also refers to the scarcity or deterioration of resources and personnel to carry out an adequate diagnosis, as in the present study, since the unavailability of the physician to provide care (p<0.001), as well as the availability of the services (p=0.001), not knowing the location of some services such as the laboratory (p=0.024) and the hygienic state of the environments where care was received (p=0.004) were associated with therapeutic adherence. ...
... Other authors, such as Gabert 27 and Owolabi 39 raised the availability and accessibility of adequate medications as important barriers to the management of hypertension, similar to what has been found in other studies on access to treatment in other chronic diseases, all of which coincides with the results of this study that identified as factors associated with adherence the means of transportation (p<0.001) and difficulty with administrative procedures (p=0.002). As consequence, in this study, not having received timely care was related to adherence (p=0.009). ...
Background Access to health services compromises therapeutic adherence in patients with arterial hypertension (HTN), which is a risk factor for cardiovascular disease and premature death. The aim of the research is to determine the influence of access to health services on adherence to antihypertensive treatment during the COVID-19 pandemic. Methods We included a cross-sectional analytical study. A survey was applied to 241 hypertensive patients at the Daniel Alcides Carrión Hospital, Callao-Peru. Data were analyzed using SPSS software. Absolute and relative frequencies were reported and the chi-square test was applied with a statistical significance level of p<0.05. In addition, multiple logistic regression analysis was performed using the Stepwise method. Results Our results show that non-adherence to treatment is associated with health expenses (ORa: 1.9 CI 95% 1.7-2.2), considers the environment clean (ORa: 1.4 IC 95% 1.2-1.8), not receiving care due to lack of a doctor (ORa: 2.8 CI 95% 1.5-3.2), difficult with procedures (ORa: 2.8 IC 95% 1.2-2.8), having difficulty with schedules (ORa: 3.7 CI 95% 2. 3-5.5), fear of receiving care at the hospital (ORa: 4.5 CI 95 % 2.7-6.8), trust in health staff (ORa: 7.5 CI 95% 2.3-10.5) and considering that the physician does not have enough knowledge (ORa: 3.1 CI 95% 2.4-7.8). Conclusion Therapeutic adherence was associated with expenses in the consultation considers the environment clean, not receiving care due to lack of a doctor, difficult with procedures, having difficulty with schedules, fear of receiving care at the hospital, trust in health staff and considering that the physician does not have enough knowledge.
... and uncontrolled DM (40%-86%) have been reported. [3,4] Similarly, the "Rule of Halves," which pertains to the gaps in HT awareness, diagnosis, treatment, and control status, is still applicable in Indian settings, creating an existing challenge in NCD management. [3,5,6] Thus, in the continuum of care of NCDs, as the first step, a prompt diagnosis of DM and HT is needed for early initiation of treatment and, hence, to prevent deadly complications. ...
... [3,4] Similarly, the "Rule of Halves," which pertains to the gaps in HT awareness, diagnosis, treatment, and control status, is still applicable in Indian settings, creating an existing challenge in NCD management. [3,5,6] Thus, in the continuum of care of NCDs, as the first step, a prompt diagnosis of DM and HT is needed for early initiation of treatment and, hence, to prevent deadly complications. ...
Background
The National Noncommunicable Disease Program of India currently recommends population-based NCD screening (PBS) among people aged ≥30 years. The low turnaround for diagnosis confirmation is a consistent issue the program has faced since its launch. The current study assessed an expanded PBS (including people 18–29 years) and intensified (home-based) diagnosis confirmation strategy for hypertension (HT) and diabetes mellitus (DM) in a routine programmatic setting.
Materials and Methods
This implementation research was conducted among all people aged ≥18 years in a rural health block in northern India. The eligible population was screened for HT and DM (using random blood sugar), and the screen positives were asked to visit a nearby public health facility (preferably) for diagnosis. An intensified home-based diagnosis confirmation was offered to screen positives who did not visit the health facility for diagnosis confirmation.
Results
Of the 2004 participants screened, 1149 (57.3%) were female and 586 (28.2%) were aged 18–29 years. A total of 353 (20.2%) and 200 (10.9%) were found newly screened positive for HT and DM, respectively. The turnout rate for facility-based confirmation ranged from 69.6% to 91.2%. The prevalence of HT and DM in people aged 18–29 years and ≥30 years was 6.1% and 2.9% and 30.0% and 26.2%, respectively. The expanded screening and intensified home-based diagnosis confirmation strategies yielded an additional 12.8% HT and 24.1% DM among the total new cases detected.
Conclusion
An expanded PBS and intensified diagnosis confirmation is feasible in a programmatic setting and has yielded additional new cases. Cost effectiveness of the above strategy must be assessed in future studies. Further, in-depth understanding of the risk perception, and potential cultural, social, and health system factors for improving the uptake of confirmatory tests is the need of the hour.
... India and other nations report a sizable unmet demand or treatment gap for various curable impairments, NCDs, and cardiovascular diseases (CVDs) [2][3][4][5] . Multiple studies have identified a significant gap in the availability of healthcare services for various communicable and non-communicable diseases in several regions of the country 1, [6][7][8][9] . It is irrefutable that these countries are in dire need of effective and well-functioning healthcare systems to address the rise in the burden of diseases. ...
Healthcare systems worldwide are grappling with the challenge of providing high-quality healthcare in the face of evolving disease patterns. India, like many other countries, faces a significant treatment gap for various curable impairments, non-communicable diseases (NCDs), and cardiovascular diseases (CVDs). To address their healthcare needs, individuals often relocate in search of better treatment options. However, no studies were conducted to understand the spatial mobility. This paper explores the determinants of spatial mobility for treatment in India using data from NSS 75th round (2017–2018). A total of 64,779 individual medical cases of different diseases were taken into consideration for our analysis. Fixed effect and multinomial regression models were used to understand diseases specific mobility for treatment. It was found that those with CVDs, NCDs, and disabilities are more prone to travel outside their district for medical care. Rural and economically disadvantaged individuals also tend to travel further for treatment. The key factors impacting treatment-seeking mobility include insurance coverage, hospital quality, cost of medicine, and cost of X-rays/surgeries. The study highlights the need for improved policies to address the gap between healthcare needs and infrastructure in India, with a focus on prioritizing the development of local healthcare facilities for disabilities, NCDs, and CVDs.
... However, this is not consistent with what was found in this study, because although 82.99% of patients had their blood pressure checked at the time of consultation, it was not found that receiving such control was significantly associated with adherence (p=0.168). It also differs from what was reported by Gabert et al., 27 in that study, which also refers to the scarcity or deterioration of resources and personnel to carry out an adequate diagnosis, as in the present study, since the unavailability of the physician to provide care (p<0.001), as well as the availability of the services (p=0.001), not knowing the location of some services such as the laboratory (p=0.024) and the hygienic state of the environments where care was received (p=0.004) were associated with therapeutic adherence. ...
... Other authors, such as Gabert 27 and Owolabi 38 raised the availability and accessibility of adequate medications as important barriers to the management of hypertension, similar to what has been found in other studies on access to treatment in other chronic diseases, all of which coincides with the results of this study that identified as factors associated with adherence the means of transportation (p<0.001) and difficulty with administrative procedures (p=0.002). As consequence, in this study, not having received timely care was related to adherence (p=0.009). ...
Background: Access to health services compromises therapeutic adherence in patients with arterial hypertension (HTN), which is a risk factor for cardiovascular disease and premature death. The aim of the research is to determine the influence of access to health services on adherence to antihypertensive treatment during the COVID-19 pandemic.
Methods: We included a cross-sectional analytical study. A survey was applied to 241 hypertensive patients at the Daniel Alcides Carrión Hospital, Callao-Peru. Data were analyzed using SPSS software. Absolute and relative frequencies were reported and the chi-square test was applied with a statistical significance level of p<0.05. In addition, multiple logistic regression analysis was performed using the Stepwise method.
Results: Our results show that non-adherence to treatment is associated with health expenses (ORa: 1.9 CI 95% 1.7-2.2), not receiving care due to lack of a doctor (ORa: 2.8 CI 95% 1.5-3.2), having difficulty with schedules (ORa: 3.7 CI 95% 2. 3-5.5), fear of receiving care at the hospital (ORa: 4.5 CI 95 % 2.7-6.8), trust in health personnel (ORa: 7.5 CI 95% 2.3-10.5) and considering that the physician does not have enough knowledge (ORa: 3.1 CI 95% 2.4-7.8).
Conclusion: Therapeutic adherence was associated with physician availability for care, difficulty with schedules, fear of being seen in the hospital, trust in health personnel, and waiting time.
... Several studies have described diabetes service readiness of health systems in low-and middle-income countries (LMICs) (Biswas et al. 2018;Elias et al. 2018;Gabert et al. 2017;Jacobs et al. 2015;Moucheraud 2018;Nuche-Berenguer and Kupfer 2018). Yet, an important gap in the literature is the study of how organizational strategies and management practices may be correlated to efficiency and quality of medical care. ...
Diabetes is a major health issue in middle-income countries like Mexico. Multidisciplinary healthcare (MHC) models aim to improve diabetes care and reduce costs. However, the relationship between management practices, efficiency, and quality of care in MHC and traditional healthcare (THC) models is unclear. This study evaluates the efficiency and quality of diabetes healthcare models in Mexico, identifying associated management practices. Methodology. Data from a retrospective longitudinal analysis were used to compare 20 THC and 20 MHC. Technical efficiency (TE) scores were estimated using data envelopment analysis (DEA), quality scores were calculated based on provider competence and patient performance. The relationship between efficiency, quality, and management practices was analyzed using positive deviance regression. Results. DEA analysis indicate higher TE in MHC units (mean score: 65, SD = 19) compared to THC units (mean score: 24, SD = 23). MHC units scored 78.55 (SD = 18.71) in performance score, while THC units scored 37.7 (SD = 18.97). MHC units also outperformed THC units in competence scores (mean: 68.71, SD = 18.31 vs. 49.97, SD = 23.31). Several management practices were associated with best performance in terms of both efficiency and quality strategic thinking, human resource management, financial management, operations management, performance management, and governance. Conclusion. This study highlights the higher efficiency of MHC models in diabetes care compared to THC models in Mexico. However, both models require improvement in quality. Understanding the relationship between management practices, efficiency, and quality can guide policymakers in enhancing diabetes care in low- and middle-income countries.
... Several studies have described diabetes service readiness of health systems in low-and middle-income countries (LMICs) (Biswas et al. 2018;Elias et al. 2018;Gabert et al. 2017;Jacobs et al. 2015;Moucheraud 2018;Nuche-Berenguer and Kupfer 2018). Yet, an important gap in the literature is the study of how organizational strategies and management practices may be correlated to e ciency and quality of medical care. ...
This study determined the efficiency of two different models of diabetes care (traditional units and multidisciplinary units), estimated quality levels, and identified management practices associated with better quality and efficiency of both models in Mexico. A random sample consisting of 40 units (20 for each type of unit), allowed us to estimate technical efficiency using data envelopment analysis (DEA) after we calculated quality scores (performance and competence). We mapped the relationship between efficiency and quality score, and using a positive deviance approach, we studied managerial determinants of best performance in terms of both efficiency and quality. We found that efficiency in multidisciplinary units was higher than in traditional units; traditional units scored very low in terms of efficiency. Likewise, in terms of the different quality metrics, the multidisciplinary units were much better evaluated than the traditional units. We found important differences in the quality scores for the different health care models. Two-thirds of the multidisciplinary units were in the best-performing group (above-median efficiency and above-median performance), and almost half of them were mapped to the high-competence quadrant. On the other hand, only 10% of the traditional units managed to position themselves in the best performance quadrant. Managerial characteristics were positively correlated with the probability of belonging to the group with the highest performance. Our findings indicate that multidisciplinary medical care can lead to better outcomes for patients with diabetes compared to traditional medical care. In both types of units, however, there is substantial opportunity to improve efficiency and quality levels.
... The average rate of absenteeism among the available staff is as high as 40%, and people often have to travel more than 6 km to reach Primary Health Centres [24]. The hard realities of rural life, such as steep terrain, infrequent transportation services, illiteracy, and financial constraints, erect further hurdles to basic health service use, driving individuals to seek care from the unorganized, informal, and expensive private healthcare sector [25]. Only 11.5% of rural households accessed primary level outpatient care (same for childbirth) in public health facilities, according to evidence, and rural households' average medical spending is increasing. ...
Indian healthcare system is in immediate need of a new healthcare delivery model to increase healthcare accessibility and improve the health outcomes of the marginalized. Inaccessibility and underutilization of Primary Health Centers (PHCs) disproportionately affect people living in remote areas. It is thus imperative for the designers, engineers, health professionals, and policymakers to come together with a collaborative mindset to develop innovative interventions that sustainably manage the accessibility of PHCs at large, promote preventive health, and thus improve the health outcomes of hard-to-reach communities. This article examines the available literature on barriers to primary healthcare in Indian context, the reason of failure of PHCs and the way forward. The article further analysis literature on existing Mobile Medical Units (MMUs) as an alternate solution to conventional PHCs and attempt to extract the major lessons to propose a mobile Primary Health Center (mPHC) in contrast to the existing conventional static PHCs. The intention is to find out the research gaps in the existing literature and try to address the same for future researchers, designers, engineers, health professionals and policy makers to think forward to make this idea of a mobile Primary Health Center (mPHC), as the main delivery model to cater basic healthcare services to the underserved communities.
... In this regard, a study conducted in China confirms a health inequality in diabetes prevalence from 2011 to 2015 that favors the rich [14]. Another study on healthcare inequalities in diabetes confirms the inability to access diabetes management technologies, with a tenfold difference in insulin pump use by type 1 diabetes patients across specialist centers in the UK [15]. However, tackling inequalities in diabetes care necessitates an understanding of current disparities throughout the entire spectrum of diabetes care-from early diagnosis to effective treatment and control [16]. ...
Objective
This study aims to assess geographic inequalities in the prevalence, awareness of diagnosis, treatment coverage and effective control of diabetes in 429 districts of Iran.
Methods
A modelling study by the small area estimation method, based on a nationwide cross-sectional survey, Iran STEPwise approach to surveillance (STEPS) 2016, was performed. The modelling estimated the prevalence, awareness of diagnosis, treatment coverage, and effective control of diabetes in all 429 districts of Iran based on data from available districts. The modelling results were provided in different geographical and socio-economic scales to make the comparison possible across the country.
Results
In 2016, the prevalence of diabetes ranged from 3.2 to 19.8% for women and 2.4 to 19.1% for men. The awareness of diagnosis ranged from 51.9 to 95.7% for women and 35.7 to 100% for men. The rate of treatment coverage ranged from 37.2 to 85.6% for women and 24.4 to 80.5% for men. The rate of effective control ranged from 12.1 to 63.6% for women and 12 to 73% for men. The highest treatment coverage rates belonged to Ardebil for women and Shahr-e-kord for men. The highest effective control rates belonged to Sanandaj for women and Nehbandan for men. Across Iran districts, there were considerable differences between the highest and lowest rates of prevalence, diagnosis awareness, treatment coverage, and effective control of diabetes. The concentration indices of diabetes prevalence, awareness of diagnosis, and treatment coverage were positive and significant for both sexes.
Conclusion
Findings of this study highlight the existence of inequalities in diagnosis awareness, treatment coverage, and effective control of diabetes in all Iran regions. More suitable population-wide strategies and policies are warranted to handle these inequalities in Iran.
