TY - JOUR
T1 - Outpatient use patterns and experiences among diabetic and hypertensive patients in fragile settings
T2 - a cross-sectional study from Lebanon
AU - Saleh, Shadi
AU - Muhieddine, Dina
AU - Hamadeh, Randa S.
AU - Dimassi, Hani
AU - Diaconu, K.
AU - Noubani, Aya
AU - Arakelyan, Stella
AU - Ager, Alastair
AU - Alameddine, Mohamad
N1 - Funding Information:
This research was funded by the National Institute for Health and Care Research (NIHR) Global Health Research Programme 16/136/100 grant to the Research Unit on Health in Situations of Fragility. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR or the UK Department of Health and Social Care.
Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/5/24
Y1 - 2022/5/24
N2 - Objectives Assess and describe the health service use and delivery patterns for non-communicable disease (NCD) services in two contrasting fragility contexts and by other principal equity-related characteristics including gender, nationality and health coverage. Setting Primary healthcare centres located in the urbanised area of Greater Beirut and the rural area of the Beqaa Valley. Design This is a cross-sectional study using a structured survey tool between January and September 2020. Participants 1700 Lebanese and Syrian refugee patients seeking primary care for hypertension and diabetes. Primary and secondary outcomes The main outcome is the comprehensiveness of service delivery comparing differences in use and service delivery patterns by fragility setting, gender, nationality and health coverage. Results Compliance with routine NCD care management (eg, counselling, immunisations, diagnostic testing and referral rates) was significantly better in Beirut compared with Beqaa. Women were significantly less likely to be offered lifestyle counselling advice and referral to cardiologists (58.4% vs 68.3% in Beqaa and 58.1% vs 62% in Beirut) and ophthalmologists, compared with men. Across both settings, there was a significant trend for Lebanese patients to receive more services and more advice related to nutrition and diabetes management (89.8% vs 85.2% and 62.4% vs 55.5%, respectively). Similarly, referral rates were higher among Lebanese refugees compared with Syrian refugees. Immunisation and diagnostic testing were significantly higher in Beirut among those who have health coverage compared with Beqaa. Conclusions The study discovered significant differences in outpatient service use by setting, nationality and gender to differentials. A rigorous and comprehensive appraisal of NCD programmes and services is imperative for providing policy makers with evidence-based recommendations to guide the design, implementation and evaluation of targeted programmes and services necessary to ensure equity in health services delivery to diabetic and hypertensive patients. Such programmes are an ethical imperative considering the protracted crises and compounded fragility.
AB - Objectives Assess and describe the health service use and delivery patterns for non-communicable disease (NCD) services in two contrasting fragility contexts and by other principal equity-related characteristics including gender, nationality and health coverage. Setting Primary healthcare centres located in the urbanised area of Greater Beirut and the rural area of the Beqaa Valley. Design This is a cross-sectional study using a structured survey tool between January and September 2020. Participants 1700 Lebanese and Syrian refugee patients seeking primary care for hypertension and diabetes. Primary and secondary outcomes The main outcome is the comprehensiveness of service delivery comparing differences in use and service delivery patterns by fragility setting, gender, nationality and health coverage. Results Compliance with routine NCD care management (eg, counselling, immunisations, diagnostic testing and referral rates) was significantly better in Beirut compared with Beqaa. Women were significantly less likely to be offered lifestyle counselling advice and referral to cardiologists (58.4% vs 68.3% in Beqaa and 58.1% vs 62% in Beirut) and ophthalmologists, compared with men. Across both settings, there was a significant trend for Lebanese patients to receive more services and more advice related to nutrition and diabetes management (89.8% vs 85.2% and 62.4% vs 55.5%, respectively). Similarly, referral rates were higher among Lebanese refugees compared with Syrian refugees. Immunisation and diagnostic testing were significantly higher in Beirut among those who have health coverage compared with Beqaa. Conclusions The study discovered significant differences in outpatient service use by setting, nationality and gender to differentials. A rigorous and comprehensive appraisal of NCD programmes and services is imperative for providing policy makers with evidence-based recommendations to guide the design, implementation and evaluation of targeted programmes and services necessary to ensure equity in health services delivery to diabetic and hypertensive patients. Such programmes are an ethical imperative considering the protracted crises and compounded fragility.
KW - DIABETES & ENDOCRINOLOGY
KW - Health policy
KW - Hypertension
KW - Organisation of health services
UR - http://www.scopus.com/inward/record.url?scp=85130929347&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2021-054564
DO - 10.1136/bmjopen-2021-054564
M3 - Article
C2 - 35613758
AN - SCOPUS:85130929347
SN - 2044-6055
VL - 12
SP - 1
EP - 12
JO - BMJ Open
JF - BMJ Open
IS - 5
M1 - e054564
ER -