Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand. Academic Article uri icon

Overview

abstract

  • BACKGROUND: Diabetes is a growing challenge in Thailand. Data to assess health system response to diabetes is scarce. We assessed what factors influence diabetes care cascade retention, under universal health coverage. METHODS: We conducted a cross-sectional analysis of the 2014 Thai National Health Examination Survey. Diabetes was defined as fasting plasma glucose ≥126mg/dL or on treatment. National and regional care cascades were constructed across screening, diagnosis, treatment, and control. Unmet need was defined as the total loss across cascade levels. Logistic regression was used to examine the demographic and healthcare factors associated with cascade attrition. FINDINGS: We included 15,663 individuals. Among Thai adults aged 20+ with diabetes, 67.0% (95% CI 60.9% to 73.1%) were screened, 34.0% (95% CI 30.6% to 37.2%) were diagnosed, 33.3% (95% CI 29.9% to 36.7%) were treated, and 26.0% (95% CI 22.9% to 29.1%) were controlled. Total unmet need was 74.0% (95% CI 70.9% to 77.1%), with regional variation ranging from 58.4% (95% CI 45.0% to 71.8%) in South to 78.0% (95% CI 73.0% to 83.0%) in Northeast. Multivariable models indicated older age (OR 1.76), males (OR 0.65), and a higher density of medical staff (OR 2.40) and health centers (OR 1.58) were significantly associated with being diagnosed among people with diabetes. Older age (OR 1.80) and higher geographical density of medical staff (OR 1.82) and health centers (OR 1.56) were significantly associated with being controlled. CONCLUSIONS: Substantial attrition in the diabetes care continuum was observed at diabetes screening and diagnosis, related to both individual and health system factors. Even with universal health insurance, Thailand still needs effective behavioral and structural interventions, especially in primary health care settings, to address unmet need in diabetes care for its population.

authors

  • Yan, Lily
  • Hanvoravongchai, Piya
  • Aekplakorn, Wichai
  • Chariyalertsak, Suwat
  • Kessomboon, Pattapong
  • Assanangkornchai, Sawitri
  • Taneepanichskul, Surasak
  • Neelapaichit, Nareemarn
  • Stokes, Andrew C

publication date

  • January 15, 2020

Research

keywords

  • Continuity of Patient Care
  • Diabetes Mellitus
  • Health Services Needs and Demand
  • Universal Health Insurance

Identity

PubMed Central ID

  • PMC6961827

Scopus Document Identifier

  • 85077941875

Digital Object Identifier (DOI)

  • 10.1155/2015/396505

PubMed ID

  • 31940366

Additional Document Info

volume

  • 15

issue

  • 1