Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, P.O. Box 36, Lebanon.
INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie- Liban), Beirut, Lebanon.
BMC Public Health. 2024 Feb 27;24(1):628. doi: 10.1186/s12889-024-18116-6.
Against the backdrop of Lebanon's escalating multifaceted crisis which resulted in medication shortages for chronic diseases and unaffordable healthcare services, the current study endeavors to shed light on a critical yet overlooked facet of the Lebanese economic crisis- its profound impact on the health-seeking behaviors of patients with hypertension and diabetes mellitus.
An exploratory cross-sectional study based on an online questionnaire was conducted on 156 adult Lebanese citizens diagnosed medically with either hypertension or diabetes. We gathered sociodemographic characteristics and healthcare-related challenges faced during the economic crisis. We also assessed stress levels using the Depression Anxiety Stress Scale (DASS-21). Descriptive and bivariate analyses were done using SPSS version 26.
The mean age of the population was 49.8 ± 17.7 years old, 51.6% were females and 48.4% were males, 29.7% had diabetes, 51.3% had hypertension and 19.0% had both diseases. Among all, 84.2% reported dissatisfaction with the current healthcare system, 31.6% reported changing their physician mainly because of unaffordable consultation fees (66%) or immigration of the physician (32%). Of those with hypertension and/or diabetes, less than 20% reported finding all their prescribed medications and 47% either modified or discontinued their treatment without seeking medical advice. In case of drug shortage, patients relied on stocked reserves (26%), alternative/generic medications (10%) and external sources for medication procurement such as relatives living abroad (41.7%), outsourcing suppliers (19.9%), dispensaries (19.6%) and NGOs (20.3%). All participants reported a high stress level (5.03/7) with a mean total DASS-21 score of 38.7 ± 35.8 that were attributed to August 4 Beirut port explosion (81.0%), global pandemic (81%), unstable political conditions (90.5%), economic crisis (96.8%), medication shortage (91.8%) and inability to access healthcare (74.1%). Higher sub-scores for anxiety, depression and total stress were insignificantly noted in participants with both hypertension and diabetes (p > 0.05).
Our findings explore how the economic crisis has taken its toll on almost all aspects of healthcare in a sample of patients with diabetes and hypertension in Lebanon. The drug shortage as well as disruptions in affordable healthcare access imposed several barriers to adequate adherence to treatment regimens and acted as important mental health stressors.
在黎巴嫩不断升级的多方面危机的背景下，慢性病药物短缺和医疗服务负担不起，当前的研究旨在揭示黎巴嫩经济危机中一个被忽视的重要方面，即其对高血压和糖尿病患者寻求医疗服务行为的深远影响。
这是一项基于在线问卷的探索性横断面研究，共纳入 156 名被诊断患有高血压或糖尿病的成年黎巴嫩公民。我们收集了社会人口学特征和经济危机期间面临的医疗保健相关挑战。我们还使用抑郁焦虑压力量表（DASS-21）评估了压力水平。使用 SPSS 版本 26 进行描述性和双变量分析。
人群的平均年龄为 49.8±17.7 岁，女性占 51.6%，男性占 48.4%，29.7%患有糖尿病，51.3%患有高血压，19.0%同时患有两种疾病。在所有参与者中，84.2%对当前的医疗保健系统不满意，31.6%主要因为咨询费用负担不起（66%）或医生移民（32%）而更换医生。在患有高血压和/或糖尿病的人群中，不到 20%的人报告说找到了所有开的药物，47%的人在没有咨询医生的情况下修改或停止治疗。在药物短缺的情况下，患者依赖储备药物（26%）、替代/通用药物（10%）以及从国外的亲戚（41.7%）、外包供应商（19.9%）、药房（19.6%）和非政府组织（20.3%）等外部来源获取药物。所有参与者报告了高压力水平（5.03/7），DASS-21 总分为 38.7±35.8，这归因于 8 月 4 日贝鲁特港口爆炸（81.0%）、全球大流行（81%）、不稳定的政治局势（90.5%）、经济危机（96.8%）、药物短缺（91.8%）和无法获得医疗保健（74.1%）。在患有高血压和糖尿病的参与者中，焦虑、抑郁和总压力的亚量表得分较高，但无统计学意义（p＞0.05）。
本研究结果揭示了在黎巴嫩患有糖尿病和高血压的患者样本中，经济危机如何对医疗保健的几乎所有方面都产生了影响。药物短缺以及获得负担得起的医疗保健服务的中断对遵守治疗方案造成了若干障碍，并成为重要的心理健康压力源。
