Birhan Desalew, Aderaw Zewudie, Agdew Eskeziaw, Siferih Melkamu
Department of Public Health, College of Medicine and Health Sciences, Debremarkos University, Debremarkos, Amhara Region, Ethiopia.
Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
PLOS Glob Public Health. 2024 Aug 7;4(8):e0003374. doi: 10.1371/journal.pgph.0003374. eCollection 2024.
Chronic disease poses a serious threat to accessible, high-quality healthcare. Community-based health insurance (CBHI) schemes provide the poor with financial security. However, there is no evidence in Ethiopia on how satisfied chronic patients are with the schemes. The objective of the current study was to evaluate the satisfaction of chronic patients with the schemes and identify contributing factors. A hospital-based explanatory sequential mixed methods study on 632 chronic patients and 12 key informants was carried out between February 28 and May 31, 2022, in the hospitals of East Gojjam, Northwest Ethiopia. Hospitals and study participants were selected using multistage sampling methods. Quantitative data was entered using Epi Data 3.1 and exported to SPSS version 25 for analysis. P value <0.05 was used to consider significant association in multivariable binary logistic regression. Thematic analysis was a method to manually review qualitative data. A narrative approach was used for integrating the two data. The mean age of study participants was 46.1 (46.1± 5.2, range: 25-82). Patients aged 45 to 64 made up the majority of the population (60.6%). Rheumatoid arthritis affected the preponderance of individuals (36.4%). The overall level of satisfaction of chronic patients with the CBHI scheme was 31% (95% CI; 27-35%). Respect and friendliness (AOR = 7.05; CI: 3.71-13.36), knowledge of benefits packages (AOR = 2.02; CI: 1.24-3.27), partial or non-availability of drugs (AOR = 0.24, AOR = 0.21, respectively), waiting times (AOR = 1.84; CI: 1.12-3.0), and availability of laboratory tests (AOR = 1.59; CI: 1.01-2.48) were significantly associated with participants' satisfaction with the schemes. Our study revealed that the overall satisfaction of chronic patients was quite low and affected by the availability of drugs and laboratory tests, caregivers' respect and friendliness, waiting times, and participant knowledge. Therefore, stakeholders must concentrate on reducing waiting times, improving the availability of drugs and laboratory tests at each hospital, opening back up community pharmacies, and promoting awareness about benefits packages primarily through health education. The main focus of researchers needs to be on nationally representative studies that include more important factors.
慢性病对可及的高质量医疗保健构成严重威胁。基于社区的医疗保险（CBHI）计划为贫困人口提供经济保障。然而，在埃塞俄比亚，尚无关于慢性病患者对这些计划满意度的证据。本研究的目的是评估慢性病患者对这些计划的满意度，并确定相关影响因素。2022年2月28日至5月31日期间，在埃塞俄比亚西北部东戈贾姆的医院，对632名慢性病患者和12名关键信息提供者开展了一项基于医院的解释性序列混合方法研究。医院和研究参与者采用多阶段抽样方法选取。定量数据使用Epi Data 3.1录入，并导出至SPSS 25版本进行分析。在多变量二元逻辑回归中，P值<0.05被视为具有显著相关性。主题分析是一种人工审查定性数据的方法。采用叙述性方法整合这两种数据。研究参与者的平均年龄为46.1岁（46.1±5.2，范围：25 - 82岁）。45至64岁的患者占大多数（60.6%）。类风湿性关节炎患者占比最大（36.4%）。慢性病患者对CBHI计划的总体满意度为31%（95%置信区间；27 - 35%）。尊重与友善（调整后比值比[AOR]=7.05；置信区间：3.71 - 13.36）、对福利套餐的了解（AOR = 2.02；置信区间：1.24 - 3.27）、药品部分或全部短缺（AOR分别为0.24、0.21）、等待时间（AOR = 1.84；置信区间：1.12 - 3.0）以及实验室检查的可及性（AOR = 1.59；置信区间：1.01 - 2.48）与参与者对这些计划的满意度显著相关。我们的研究表明，慢性病患者的总体满意度相当低，且受到药品和实验室检查的可及性、护理人员的尊重与友善、等待时间以及参与者的了解程度的影响。因此，利益相关者必须专注于减少等待时间，提高各医院药品和实验室检查的可及性，重新开放社区药房，并主要通过健康教育提高对福利套餐的认知度。研究人员的主要重点应放在具有全国代表性且包含更重要因素的研究上。
