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Title: Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand
Authors: Lily D. Yan
Piya Hanvoravongchai
Wichai Aekplakorn
Suwat Chariyalertsak
Pattapong Kessomboon
Sawitri Assanangkornchai
Surasak Taneepanichskul
Nareemarn Neelapaichit
Andrew C. Stokes
Chulalongkorn University
Boston University School of Public Health
Khon Kaen University
Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Prince of Songkla University
Boston Medical Center
Chiang Mai University
Keywords: Agricultural and Biological Sciences;Biochemistry, Genetics and Molecular Biology;Multidisciplinary
Issue Date: 1-Jan-2020
Citation: PloS one. Vol.15, No.1 (2020), e0226286
Abstract: 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.
ISSN: 19326203
Appears in Collections:Scopus 2020

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