对尼日利亚西南部一家教学医院的2型糖尿病患者的血糖控制及医疗融资模式的评估

An Assessment of Glycaemic Control and Modes of Health Financing among Type 2 Diabetic Patients Attending a Teaching Hospital in South-western Nigeria.

作者信息

Attoye T E, Adebobola P A, Inem V

机构信息

Department of Family Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.

Department of Community Health and Primary Care, College of Medicine University of Lagos, Nigeria.

出版信息

West Afr J Med. 2020 Jul-Aug;37(3):237-247.

PMID:32476117

Abstract

BACKGROUND

Type 2 diabetes mellitus can be a major drain on resources due to lifelong treatment and risk of catastrophic expenditure from treatment of complications. The prevalence has been projected to rise to alarming levels in developing countries. This study aimed to assess the levels of, and associations between good glycaemic control among patients with type 2 diabetes and their modes of financing healthcare.

METHODS

In this hospital based descriptive cross-sectional study, 260 patients being managed for type 2 diabetes at the outpatient clinics of Lagos University Teaching Hospital, Lagos were recruited by systematic random sampling method. All participants received a HBA1C test to assess glycaemic control and a composite interviewer administered questionnaire adapted from the MMAS-8 and diabetes care profile to assess medication adherence, modes of financing and other factors related to disease management.

RESULTS

Of the 260 study participants, 34.62% (90) had good glycaemic control. In the mode of health care financing only 15% (39) paid by health insurance (NHIS), while 85% of the respondents' payment was by out-of-pocket (OOP) payment. About half of these OOP payments were made by family, friends and others (in this study, a proxy for informal means of pooling finances). Significant associations were found between glycaemic control and adherence (2 13.93, p=0.001), glycaemic control and mode of payment (2 15.30, p=0.0000) and also adherence and mode of payment (2 16.59, p =0.002).

CONCLUSION

In this study, only about a third of patients with type 2 diabetes achieved good glycaemic control, most patients used OOP financing and patients with OOP financing had poorer adherence and poorer glycaemic control. There is a need to scale up health insurance to improve health outcomes in diabetes management and protect people in developing countries from the burden of health care costs of chronic diseases like type 2 diabetes.

摘要

背景

2型糖尿病由于需要终身治疗且存在并发症治疗导致灾难性支出的风险，可能会成为资源的一大消耗。预计在发展中国家，其患病率将升至惊人水平。本研究旨在评估2型糖尿病患者的血糖良好控制水平及其医疗保健融资方式之间的关系。

方法

在这项基于医院的描述性横断面研究中，采用系统随机抽样方法，从拉各斯大学教学医院拉各斯门诊正在接受2型糖尿病治疗的260名患者中招募研究对象。所有参与者均接受糖化血红蛋白（HBA1C）检测以评估血糖控制情况，并接受一份综合访谈问卷，该问卷改编自MMAS - 8和糖尿病护理概况，用于评估药物依从性、融资方式以及与疾病管理相关的其他因素。

结果

在260名研究参与者中，34.62%（90人）血糖控制良好。在医疗保健融资方式方面，只有15%（39人）通过医疗保险（国家健康保险计划，NHIS）支付，而85%的受访者是自掏腰包支付。这些自掏腰包支付中约一半是由家人、朋友和其他人支付（在本研究中，这是一种非正式资金筹集方式的代表）。研究发现血糖控制与依从性之间存在显著关联（χ² = 13.93，p = 0.001），血糖控制与支付方式之间存在显著关联（χ² = 15.30，p = 0.0000），依从性与支付方式之间也存在显著关联（χ² = 16.59，p = 0.002）。