Barriers to Accessing Quality Health Coverage and their association with Medication Adherence in patients with Type 2 Diabetes Mellitus at a hospital in Peru
César Antonio Bonilla Asalde, Oriana Rivera Lozada De Bonilla, Isabel Cristina Rivera Lozada, Víctor Baca Carrasco, Daniella Nicolle Bonilla Pizarro , Luz Chávez Huamani, Juan Hiyagon Kian
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ABSTRACT
Background: Diabetes mellitus is a major challenge faced by health systems around
the world, especially in low- and middle-income countries where, besides
chronic non-communicable diseases, there is an overlap of infectious diseases.
Aim: To determine the barriers to accessing health services associated with
treatment adherence in patients with T2DM.
Methodology: Analytical cross-sectional study. We conducted a structured survey to
address sociodemographic and clinical aspects as well as access to health
services and adherence to treatment according to the Tanahashi model and the
Morisky-Green test. The survey was administered to 240 patients diagnosed
withT2DM who attended the Daniel Alcides Carrión National Hospital in the region
of Callao from January to June, 2019. The factors were determined through
logistic regression, and odds ratios (OR) and 95% confidence intervals (CI)
were calculated.
Results: Sociodemographic, clinical and health care access factors were
determined inthe multivariate analysis with medication non-adherence: male
gender (OR=9.89; CI95%: 5.70-18.95; p=0.000); schooling: without formal
education (OR=14.50; IC95%: 5.88-17.56; p=0.001); obesity (OR=10.50; IC95%:
3.81-13.50; p=0.003); having a comorbidity (OR=3.80; IC95%: 2.57-4.37;
p=0.001); not trusting health care staff (OR=8.51; IC95%: 5.2-12.50; p=0.002); considering
that the prescribed treatment will not improve their health (OR=6.54; IC95%:
3.71-10.13; p=0.003); not having taken the medication because they lacked money
to buy it at some point (OR=4.74; IC95%:
2.79-9.51; p=0.003), not having attended consultation due to lack of money for
transport at some point (OR=4.71; CI95%: 3.60-9.52; p=0.003); considering that waiting
time for health care is inadequate (OR=5.61; CI95%: 2.60-8.15; p=0.000): considering
that health personnel are not trained to perform their health care (OR=3.76;
CI95%: 1.51-4.80; p=0.001).
Conclusion: Access to quality health services is a priority to control T2DM, which
if left unattended, could become the greatest global health challenge in the
future.
Keywords: Diabetes Mellitus, Health Services Accessibility, Treatment Adherence
and Compliance. (MESH)
ABSTRACT
Background: Diabetes mellitus is a major challenge faced by health systems around
the world, especially in low- and middle-income countries where, besides
chronic non-communicable diseases, there is an overlap of infectious diseases.
Aim: To determine the barriers to accessing health services associated with
treatment adherence in patients with T2DM.
Methodology: Analytical cross-sectional study. We conducted a structured survey to
address sociodemographic and clinical aspects as well as access to health
services and adherence to treatment according to the Tanahashi model and the
Morisky-Green test. The survey was administered to 240 patients diagnosed
withT2DM who attended the Daniel Alcides Carrión National Hospital in the region
of Callao from January to June, 2019. The factors were determined through
logistic regression, and odds ratios (OR) and 95% confidence intervals (CI)
were calculated.
Results: Sociodemographic, clinical and health care access factors were
determined inthe multivariate analysis with medication non-adherence: male
gender (OR=9.89; CI95%: 5.70-18.95; p=0.000); schooling: without formal
education (OR=14.50; IC95%: 5.88-17.56; p=0.001); obesity (OR=10.50; IC95%:
3.81-13.50; p=0.003); having a comorbidity (OR=3.80; IC95%: 2.57-4.37;
p=0.001); not trusting health care staff (OR=8.51; IC95%: 5.2-12.50; p=0.002); considering
that the prescribed treatment will not improve their health (OR=6.54; IC95%:
3.71-10.13; p=0.003); not having taken the medication because they lacked money
to buy it at some point (OR=4.74; IC95%:
2.79-9.51; p=0.003), not having attended consultation due to lack of money for
transport at some point (OR=4.71; CI95%: 3.60-9.52; p=0.003); considering that waiting
time for health care is inadequate (OR=5.61; CI95%: 2.60-8.15; p=0.000): considering
that health personnel are not trained to perform their health care (OR=3.76;
CI95%: 1.51-4.80; p=0.001).
Conclusion: Access to quality health services is a priority to control T2DM, which
if left unattended, could become the greatest global health challenge in the
future.
Keywords: Diabetes Mellitus, Health Services Accessibility, Treatment Adherence
and Compliance. (MESH)