Global Health Institute, American University of Beirut, Beirut, Lebanon.
Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Front Public Health. 2022 Jul 25;10:844864. doi: 10.3389/fpubh.2022.844864. eCollection 2022.
The management of NCDs is a growing challenge in low- and middle-income settings with the increasing prevalence and the associated demands that such conditions make on health systems. Fragile settings both exacerbate the risk of NCDs and undermine systems capacity. Lebanon is a setting where strategies to address rising NCDs burden have faced particularly acute contextual challenges.
We conducted a cross-sectional survey with patients accessing non-communicable disease across 11 primary care centers within the Greater Beirut and Beqaa areas. Response were received from 1,700 patients. We generated a Clinical Management Index Score as a measure of quality of care, and scores related to a range of socio-demographic characteristics and other context specific variables.
Significantly higher clinical management index scores (better quality of care) were associated with patients living in the semi-urban/rural context of Beqaa (compared to Greater Beirut), having health insurance coverage, aged above 60, having high levels of educational attainment, and making partial or full payment for their treatment. Relatively lower index scores (poorer quality of care) were associated with Syrian nationality (compared to Lebanese) and with patients suffering from diabetes or hypertension (compared to comorbid patients).
The study identified a wide margin for improving quality of NCDs care in fragile contexts with particular gaps identified in referral to ophthalmology, accessing all prescribed medication and receiving counseling for smoking cessation. Additionally, findings indicate a number of predictors of comparatively poor quality of care that warrant attention, notably with regard to Syrian nationality/legal status, lack of health coverage, seeking free health provision and lower educational attachment. Although these are all relevant risk factors, the findings call on donor agencies, NGOs and provider institutions to design targeted programs and activities that especially ensure equitable delivery of services to diabetic and hypertensive patients with compounded vulnerability as a result of a number of these factors.
在中低收入国家，非传染性疾病的管理是一个日益严峻的挑战，因为这些疾病的发病率不断上升，对卫生系统造成了相应的压力。脆弱的环境不仅加剧了非传染性疾病的风险，还削弱了系统的能力。黎巴嫩就是一个在应对不断上升的非传染性疾病负担方面面临着特别尖锐的背景挑战的国家。
我们在大贝鲁特和贝卡地区的 11 个初级保健中心对患有非传染性疾病的患者进行了横断面调查。共收到 1700 名患者的回复。我们生成了一个临床管理指数评分，作为护理质量的衡量标准，评分与一系列社会人口特征和其他特定背景的变量有关。
临床管理指数评分（护理质量更好）显著较高的患者，与居住在贝卡半城市/农村地区（与大贝鲁特相比）、有医疗保险覆盖、年龄在 60 岁以上、教育程度较高、以及部分或全部支付治疗费用的患者有关。指数评分相对较低（护理质量较差）的患者与叙利亚国籍（与黎巴嫩相比）和患有糖尿病或高血压的患者（与合并症患者相比）有关。
该研究在脆弱的环境中发现了改善非传染性疾病护理质量的广泛空间，特别是在眼科转诊、获取所有规定药物和接受戒烟咨询方面存在差距。此外，研究结果还表明了一些预测护理质量较差的因素，特别是与叙利亚国籍/法律地位、缺乏医疗保险、寻求免费医疗服务以及教育程度较低有关。尽管这些都是相关的风险因素，但研究结果呼吁捐助机构、非政府组织和提供者机构设计有针对性的项目和活动，特别是确保向由于多种因素而变得更加脆弱的糖尿病和高血压患者提供公平的服务。
