Aljadeeah Saleh, Nagel Eckhard, Wirtz Veronika J
University of Bayreuth, Institute of Medical Management and Health Sciences, Prieserstr. 2, 95440, Bayreuth, Germany.
Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd floor, Boston, MA, 02118, USA.
BMC Health Serv Res. 2021 Oct 13;21(1):1088. doi: 10.1186/s12913-021-07124-6.
Low- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines.
Outpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries' sex, age, and governorate.
Beneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government.
Additional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria.
低收入和中等收入国家承受着非传染性疾病（NCDs）死亡和发病的最高负担。在过去几十年中，叙利亚经历了从传染病到非传染性疾病的流行病学转变。尽管叙利亚心血管疾病（CVDs）和糖尿病的患病率很高，但对于这些疾病的药物使用或处方情况知之甚少。本研究的目的是呈现叙利亚政府医疗保险患者中用于心血管疾病和糖尿病的配药模式及比率，并研究这些药物配药方面的年龄、性别和地区差异。
获取了2018年6月至2019年5月期间81314名有政府医疗保险的成年人的门诊配药数据。配药率表示为每1000名受益人每天的限定日剂量（DDDs）数（DID）。DID是药物利用研究中用于控制国家之间或国家内部人口规模差异或变化的一种度量。DID的数量根据受益人的性别、年龄和省份进行了调整。
受益人接受了302.09个心血管疾病药物的DID和35.66个糖尿病药物的DID，其中胰岛素为0.96个DID（占糖尿病药物总量的2.99%）。在研究期间，心血管疾病和糖尿病药物的配药率较低，与东地中海地区其他国家或欧洲这些药物的配药率相比，胰岛素配药率极低。我们发现女性受益人（249.59个DID）的心血管疾病药物配药率低于男性受益人（388.80个DID）。同样，女性受益人（29.42个DID）的糖尿病药物配药率低于男性受益人（45.98个DID）。此外，与完全或大部分由叙利亚政府控制的其他省份相比，部分由叙利亚政府控制的一些省份的心血管疾病和糖尿病药物配药率较低，胰岛素配药率极低甚至没有。
需要做出更多努力来提高对心血管疾病和糖尿病预防与管理的认识，特别是在叙利亚女性中，并考虑可能影响医疗服务获取的文化问题。迫切需要应对冲突造成的政治和地理挑战，这些挑战限制了叙利亚一些地区获取心血管疾病和糖尿病药物的机会。
