Organization of primary health care for diabetes and hypertension in high, low and middle income countries

Lall, Dorothy; Prabhakaran, Dorairaj

doi:10.1586/14779072.2014.928591

Cited by 20 publications

(21 citation statements)

References 55 publications

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“…Both India and China have committed public funds into healthcare programs for NCDs [29]. China has launched a number of health reforms aimed at improving social health insurance schemes and strengthening primary healthcare [52, 60, 80]. India’s publically-funded health schemes have focused exclusively on inpatient secondary and tertiary care to the neglect of primary healthcare [64] and progress has been impeded by the country’s vast geographic and ethnic diversity [61].…”

Section: Discussionmentioning

confidence: 99%

Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE)

Gwatidzo

Williams

2017

BMC Geriatr

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BackgroundExpenditure on medications for highly prevalent chronic conditions such as diabetes mellitus (DM) can result in financial impoverishment. People in developing countries and in low socioeconomic status groups are particularly vulnerable. China and India currently hold the world’s two largest DM populations. Both countries are ageing and undergoing rapid economic development, urbanisation and social change. This paper assesses the determinants of DM medication use and catastrophic expenditure on medications in older adults with DM in China and India.MethodsUsing national standardised data collected from adults aged 50 years and above with DM (self-reported) in China (N = 773) and India (N = 463), multivariable logistic regression describes: 1) association between respondents’ socio-demographic and health behavioural characteristics and the dependent variable, DM medication use, and 2) association between DM medication use (independent variable) and household catastrophic expenditure on medications (dependent variable) (China: N = 630; India: N = 439). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007–2010).ResultsPrevalence of DM medication use was 87% in China and 71% in India. Multivariable analysis indicates that people reporting lifestyle modification were more likely to use DM medications in China (OR = 6.22) and India (OR = 8.45). Women were more likely to use DM medications in China (OR = 1.56). Respondents in poorer wealth quintiles in China were more likely to use DM medications whereas the reverse was true in India. Almost 17% of people with DM in China experienced catastrophic healthcare expenditure on medications compared with 7% in India. Diabetes medication use was not a statistically significant predictor of catastrophic healthcare expenditure on medications in either country, although the odds were 33% higher among DM medications users in China (OR = 1.33).ConclusionsThe country comparison reflects major public policy differences underpinned by divergent political and ideological frameworks. The DM epidemic poses huge public health challenges for China and India. Ensuring equitable and affordable access to medications for DM is fundamental for healthy ageing cohorts, and is consistent with the global agenda for universal healthcare coverage.

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Section: Discussionmentioning

confidence: 99%

Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE)

Gwatidzo

Williams

2017

BMC Geriatr

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“…Primary care can be an effective and cost-effective platform for tackling non-communicable diseases 8 9. However, public primary facilities in India often lack the human resources, diagnostic equipment and drugs to diagnose and treat the nearly 200 million adults living with hypertension in India 10–13.…”

Section: Introductionmentioning

confidence: 99%

Reasons for low utilisation of public facilities among households with hypertension: analysis of a population-based survey in India

et al. 2018

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IntroductionIn India, for most patients, primary healthcare remains the intended entry point for the management of non-communicable disease risk factors. The extent and determinants of non-utilisation of public primary care among households with hypertension are not well examined. We explored health facility utilisation patterns and reasons for non-utilisation of public facilities in 21 states and union territories in India, with a focus on hypertension.MethodsWe used data from the 2012–2013 District Level Household and Facility Survey. We examined the self-reported usual source of care for all households, households with hypertension and─to understand multimorbidity for those with hypertension─households with hypertension and diabetes. Hypertension was defined by self-reported diagnosis or measurement of systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Diabetes was defined by self-reported diagnosis or fasting blood glucose level ≥ 7.0 mmol/L or non-fasting blood glucose level ≥ 11.1 mmol/L. We assessed facility utilisation choice and reasons for non-utilisation of public facilities by household with the presence of hypertension alone and hypertension with diabetes.ResultsIn 336 305 households, 37.6% (N=126 597) had at least one household member with hypertension, while 15.9% (N=53 385) had members with hypertension and diabetes. 20.0% of households sought care at public primary clinics, 29.9% at public hospitals and 48.3% at private facilities. Choice of private facilities increased with the burden of disease. Households with hypertension only and hypertension and diabetes cited quality reasons for non-utilisation of public facilities more than households without hypertension.ConclusionHouseholds, particularly those with hypertension, chose private over public primary facilities for usual care. Quality of care was an important determinant of facility choice in households with hypertension and diabetes. With the increase in hypertension and cardiovascular disease in India, quality of public primary healthcare must be addressed for current policy to become reality.

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“…Many authors have expressed hope in finding solutions to the problems of mental health service delivery through mobile phones in the region (Aggarwal, 2012;Brian and Ben-Zeev, 2014). Some studies from India have also reported that health service delivery through mobile phones may be useful in a spectrum of chronic disorders (Dubey et al, 2014;Lall and Prabhakaran, 2014) including mental health (Bali and Singh, 2007;Thara, 2012).…”

Section: Discussionmentioning

confidence: 99%

Opportunities and barriers in service delivery through mobile phones (mHealth) for Severe Mental Illnesses in Rajasthan, India: A multi-site study

Jain

Singh

Koolwal

et al. 2015

Asian Journal of Psychiatry

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Organization of primary health care for diabetes and hypertension in high, low and middle income countries

Cited by 20 publications

References 55 publications

Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE)

Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE)

Reasons for low utilisation of public facilities among households with hypertension: analysis of a population-based survey in India

Opportunities and barriers in service delivery through mobile phones (mHealth) for Severe Mental Illnesses in Rajasthan, India: A multi-site study

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