Faculty of Nursing, Mahidol University, Bangkok, Thailand.
Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
BMC Health Serv Res. 2024 Sep 27;24(1):1118. doi: 10.1186/s12913-024-11562-3.
Metabolic syndrome (MetS) in older adults with hypertension, diabetes, and hyperlipidemia increases the risks of cardiovascular diseases by 2.5 times and type 2 diabetes by five times. This study aimed to explain the multilevel relationships between health service system factors and individual-level factors influencing the control of MetS among older adults with NCDs receiving health care services at the NCD Plus clinics of hospitals in 1 year.
This cross-sectional analytical study employed a systematic sampling method to have two groups of samples from 4 regions of Thailand: (1) 600 older adults having at least one diagnosis of NCDs receiving services at NCD Plus clinics and (2) 12 nurses in charge of the NCD Plus clinics at the hospitals providing services to these patient samples. Data were analyzed using multilevel logistic regression analysis.
24% of older adults with NCDs can control MetS within one year. The MetS escalation from the initial assessment to 1-year follow-up varied according to the level of the hospitals. The transition from MetS to non-MetS status was rare in older adults with NCDs. Among health service system factors, complete screening for MetS influenced 1-year MetS control (95% CI [1.06, 2.92]). Older adults who were female and who had polypharmacy had a 66% (95% CI [0.22, 0.53]) and a 54% (95% CI [0.29 - 0.71]) reduction chance in MetS control. Older adults, who were ≥ 80 years old, labor-employed, healthy dietary patterns, and medication adherence increased chances of controlling MetS by 2.38 times (95% CI [1.12, 5.05]), 2.14 times (95% CI [1.03, 4.42]), 1.61 times (95% CI [1.06-2.46]), and 3.18 times (95% CI [1.51, 6.70]), respectively.
NCDs Plus clinics that provide complete screening for MetS significantly enhance their effectiveness in reducing the proportion of older adults with MetS. In addition, the service should pay attention to older adults who are female, are retired, and take multiple medications to achieve MetS control better. The insights gained from such an analysis could be instrumental in pinpointing the resources necessary to bolster the efficacy of NCD Plus clinics.
患有高血压、糖尿病和高血脂症的老年患者，如果同时患有代谢综合征（MetS），其心血管疾病风险会增加 2.5 倍，2 型糖尿病风险会增加 5 倍。本研究旨在解释卫生服务系统因素和个体因素之间的多层次关系，这些因素影响着在医院的 NCD 加护诊所接受护理服务的 NCD 老年患者在一年内控制 MetS 的情况。
本横断面分析性研究采用系统抽样方法，从泰国的 4 个地区抽取了两组样本：（1）600 名至少患有一种 NCD 且在 NCD 加护诊所接受服务的老年患者；（2）12 名负责医院 NCD 加护诊所的护士，这些医院为这些患者样本提供服务。数据采用多水平逻辑回归分析进行分析。
24%的 NCD 老年患者在一年内能够控制 MetS。从初始评估到 1 年随访，MetS 的严重程度因医院的级别而有所不同。患有 NCD 的老年患者从 MetS 转为非 MetS 状态的情况很少见。在卫生服务系统因素中，全面筛查 MetS 会影响 1 年内 MetS 的控制（95%CI[1.06,2.92]）。女性和同时服用多种药物的老年患者控制 MetS 的机会分别降低了 66%（95%CI[0.22,0.53]）和 54%（95%CI[0.29-0.71]）。年龄≥80 岁、有工作、饮食健康和遵医嘱服药的老年患者控制 MetS 的机会分别增加了 2.38 倍（95%CI[1.12,5.05]）、2.14 倍（95%CI[1.03,4.42]）、1.61 倍（95%CI[1.06-2.46]）和 3.18 倍（95%CI[1.51,6.70]）。
提供全面筛查 MetS 的 NCD 加护诊所可显著提高降低患有 MetS 的老年患者比例的效果。此外，该服务应关注女性、退休和服用多种药物的老年患者，以更好地控制 MetS。对这种分析的深入了解有助于确定加强 NCD 加护诊所效力所需的资源。
