Abbott Patricia, Banerjee Tanima, Aruquipa Yujra Amparo Clara, Xie Boqin, Piette John
University of Michigan School of Nursing; Ann Arbor, Michigan, United States of America.
Institute for Healthcare Policy and Innovation, University of Michigan; Ann Arbor, Michigan, United States of America.
PLoS One. 2018 Feb 7;13(2):e0189218. doi: 10.1371/journal.pone.0189218. eCollection 2018.
This study seeks to develop an understanding that can guide development of programs to improve health and care for individuals with Non-Communicable Diseases (NCDs) in La Paz, Bolivia, where NCDs are prevalent and primary care systems are weak. This exploratory investigation examines the characteristics of chronic disease patients in the region, key health related behaviors, and their perceptions of the care that they receive. The longer-term goal is to lay groundwork for interventional studies based on the principles of the Chronic Care Model (CCM).
The study is based on two surveys of adults (> 18 years old) administered in 2014 in La Paz, Bolivia. A total of 1165 adult patients participated in the first screening survey. A post-screening second survey, administered only on those who qualified based on Survey 1, collected more detailed information about the subjects' general health and health related personal circumstances, several health behaviors, health literacy, and their perceptions of care received. A final data set of 651 merged records were used for analysis.
Characteristic of a low-income country, the majority of participants had low levels of education, income, health literacy and high rates of under/unemployment. Nearly 50% of participants reported 2 or more NCDs. Seventy-four percent (74%) of respondents reported low levels of medication adherence and 26% of the population was found to have an undiagnosed depressive disorder. Overall, the perception of care quality was low (60%), particularly in those under the age of 45. Significant relationships emerged between several sociodemographic characteristics, health behaviors, and perceptions that have major implications for improving NCD care in this population.
These findings illustrate some of the challenges facing low-income countries where reversing the tide of NCDs is of great importance. The prevalence of NCDs coupled with challenging social determinants of health, poor medication adherence, low health literacy, and perceptions of low quality of healthcare highlight several areas of opportunity for intervention.
本研究旨在形成一种认识，以指导相关项目的开展，从而改善玻利维亚拉巴斯非传染性疾病（NCDs）患者的健康状况和医疗护理，在拉巴斯，非传染性疾病普遍存在且初级医疗系统薄弱。这项探索性调查研究了该地区慢性病患者的特征、关键的健康相关行为以及他们对所接受护理的看法。长期目标是基于慢性病护理模式（CCM）的原则为干预性研究奠定基础。
该研究基于2014年在玻利维亚拉巴斯对成年人（>18岁）进行的两项调查。共有1165名成年患者参与了首次筛查调查。仅对那些根据调查1符合条件的人进行了筛查后的第二次调查，收集了有关受试者总体健康状况、与健康相关的个人情况、几种健康行为、健康素养以及他们对所接受护理看法的更详细信息。最终使用了包含651条合并记录的数据集进行分析。
作为低收入国家的特征，大多数参与者教育水平低、收入低、健康素养低且失业率/未充分就业率高。近50%的参与者报告患有两种或更多种非传染性疾病。74%的受访者报告药物依从性低，并且发现26%的人口患有未确诊的抑郁症。总体而言，对护理质量的看法较低（60%），尤其是45岁以下的人群。在几个社会人口学特征、健康行为和看法之间出现了显著关系，这些关系对改善该人群的非传染性疾病护理具有重要意义。
这些发现说明了低收入国家在扭转非传染性疾病趋势至关重要的情况下所面临的一些挑战。非传染性疾病的流行，再加上具有挑战性的健康社会决定因素、较差的药物依从性、较低的健康素养以及对医疗保健质量的低看法，突出了几个干预机会领域。
