Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand.
BACKGROUND:Diabetes is a growing challenge in Thailand. Data to assess health system response to diabetes is scarce. We assessed what factors influence diabetes care cascade retention, under universal health coverage. METHODS:We conducted a cross-sectional analysis of the 2014 Thai National Health E...
Main Authors: | , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Public Library of Science (PLoS)
2020-01-01
|
Series: | PLoS ONE |
Online Access: | https://doi.org/10.1371/journal.pone.0226286 |
id |
doaj-40d78d23422a4582bbfba0e1d94e07c5 |
---|---|
record_format |
Article |
spelling |
doaj-40d78d23422a4582bbfba0e1d94e07c52021-03-03T21:22:40ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01151e022628610.1371/journal.pone.0226286Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand.Lily D YanPiya HanvoravongchaiWichai AekplakornSuwat ChariyalertsakPattapong KessomboonSawitri AssanangkornchaiSurasak TaneepanichskulNareemarn NeelapaichitAndrew C StokesBACKGROUND:Diabetes is a growing challenge in Thailand. Data to assess health system response to diabetes is scarce. We assessed what factors influence diabetes care cascade retention, under universal health coverage. METHODS:We conducted a cross-sectional analysis of the 2014 Thai National Health Examination Survey. Diabetes was defined as fasting plasma glucose ≥126mg/dL or on treatment. National and regional care cascades were constructed across screening, diagnosis, treatment, and control. Unmet need was defined as the total loss across cascade levels. Logistic regression was used to examine the demographic and healthcare factors associated with cascade attrition. FINDINGS:We included 15,663 individuals. Among Thai adults aged 20+ with diabetes, 67.0% (95% CI 60.9% to 73.1%) were screened, 34.0% (95% CI 30.6% to 37.2%) were diagnosed, 33.3% (95% CI 29.9% to 36.7%) were treated, and 26.0% (95% CI 22.9% to 29.1%) were controlled. Total unmet need was 74.0% (95% CI 70.9% to 77.1%), with regional variation ranging from 58.4% (95% CI 45.0% to 71.8%) in South to 78.0% (95% CI 73.0% to 83.0%) in Northeast. Multivariable models indicated older age (OR 1.76), males (OR 0.65), and a higher density of medical staff (OR 2.40) and health centers (OR 1.58) were significantly associated with being diagnosed among people with diabetes. Older age (OR 1.80) and higher geographical density of medical staff (OR 1.82) and health centers (OR 1.56) were significantly associated with being controlled. CONCLUSIONS:Substantial attrition in the diabetes care continuum was observed at diabetes screening and diagnosis, related to both individual and health system factors. Even with universal health insurance, Thailand still needs effective behavioral and structural interventions, especially in primary health care settings, to address unmet need in diabetes care for its population.https://doi.org/10.1371/journal.pone.0226286 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lily D Yan Piya Hanvoravongchai Wichai Aekplakorn Suwat Chariyalertsak Pattapong Kessomboon Sawitri Assanangkornchai Surasak Taneepanichskul Nareemarn Neelapaichit Andrew C Stokes |
spellingShingle |
Lily D Yan Piya Hanvoravongchai Wichai Aekplakorn Suwat Chariyalertsak Pattapong Kessomboon Sawitri Assanangkornchai Surasak Taneepanichskul Nareemarn Neelapaichit Andrew C Stokes Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand. PLoS ONE |
author_facet |
Lily D Yan Piya Hanvoravongchai Wichai Aekplakorn Suwat Chariyalertsak Pattapong Kessomboon Sawitri Assanangkornchai Surasak Taneepanichskul Nareemarn Neelapaichit Andrew C Stokes |
author_sort |
Lily D Yan |
title |
Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand. |
title_short |
Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand. |
title_full |
Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand. |
title_fullStr |
Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand. |
title_full_unstemmed |
Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand. |
title_sort |
universal coverage but unmet need: national and regional estimates of attrition across the diabetes care continuum in thailand. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2020-01-01 |
description |
BACKGROUND:Diabetes is a growing challenge in Thailand. Data to assess health system response to diabetes is scarce. We assessed what factors influence diabetes care cascade retention, under universal health coverage. METHODS:We conducted a cross-sectional analysis of the 2014 Thai National Health Examination Survey. Diabetes was defined as fasting plasma glucose ≥126mg/dL or on treatment. National and regional care cascades were constructed across screening, diagnosis, treatment, and control. Unmet need was defined as the total loss across cascade levels. Logistic regression was used to examine the demographic and healthcare factors associated with cascade attrition. FINDINGS:We included 15,663 individuals. Among Thai adults aged 20+ with diabetes, 67.0% (95% CI 60.9% to 73.1%) were screened, 34.0% (95% CI 30.6% to 37.2%) were diagnosed, 33.3% (95% CI 29.9% to 36.7%) were treated, and 26.0% (95% CI 22.9% to 29.1%) were controlled. Total unmet need was 74.0% (95% CI 70.9% to 77.1%), with regional variation ranging from 58.4% (95% CI 45.0% to 71.8%) in South to 78.0% (95% CI 73.0% to 83.0%) in Northeast. Multivariable models indicated older age (OR 1.76), males (OR 0.65), and a higher density of medical staff (OR 2.40) and health centers (OR 1.58) were significantly associated with being diagnosed among people with diabetes. Older age (OR 1.80) and higher geographical density of medical staff (OR 1.82) and health centers (OR 1.56) were significantly associated with being controlled. CONCLUSIONS:Substantial attrition in the diabetes care continuum was observed at diabetes screening and diagnosis, related to both individual and health system factors. Even with universal health insurance, Thailand still needs effective behavioral and structural interventions, especially in primary health care settings, to address unmet need in diabetes care for its population. |
url |
https://doi.org/10.1371/journal.pone.0226286 |
work_keys_str_mv |
AT lilydyan universalcoveragebutunmetneednationalandregionalestimatesofattritionacrossthediabetescarecontinuuminthailand AT piyahanvoravongchai universalcoveragebutunmetneednationalandregionalestimatesofattritionacrossthediabetescarecontinuuminthailand AT wichaiaekplakorn universalcoveragebutunmetneednationalandregionalestimatesofattritionacrossthediabetescarecontinuuminthailand AT suwatchariyalertsak universalcoveragebutunmetneednationalandregionalestimatesofattritionacrossthediabetescarecontinuuminthailand AT pattapongkessomboon universalcoveragebutunmetneednationalandregionalestimatesofattritionacrossthediabetescarecontinuuminthailand AT sawitriassanangkornchai universalcoveragebutunmetneednationalandregionalestimatesofattritionacrossthediabetescarecontinuuminthailand AT surasaktaneepanichskul universalcoveragebutunmetneednationalandregionalestimatesofattritionacrossthediabetescarecontinuuminthailand AT nareemarnneelapaichit universalcoveragebutunmetneednationalandregionalestimatesofattritionacrossthediabetescarecontinuuminthailand AT andrewcstokes universalcoveragebutunmetneednationalandregionalestimatesofattritionacrossthediabetescarecontinuuminthailand |
_version_ |
1714817201285890048 |