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. 2020 Jan 15;15(1):e0226286.
doi: 10.1371/journal.pone.0226286. eCollection 2020.

Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand

Lily D Yan  1 , Piya Hanvoravongchai  2 , Wichai Aekplakorn  3 , Suwat Chariyalertsak  4   5 , Pattapong Kessomboon  6 , Sawitri Assanangkornchai  7 , Surasak Taneepanichskul  8 , Nareemarn Neelapaichit  9   10 , Andrew C Stokes  11
Affiliations

Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand

Lily D Yan et al. PLoS One. .

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Diabetes care cascade framework.
Fig 2
Fig 2. Diabetes care cascade, Thailand 2014.
Point estimates are shown, with 95% confidence intervals in brackets. Among all people with diabetes, 67.0% were ever screened for diabetes (33.0% relative loss), 34.0% were ever diagnosed (49.3% loss), 33.3% were ever treated (2.0% loss), and 26.0% were controlled with fasting plasma glucose <183 mg/dL (21.9% relative loss). Unmet need was 74.0% across the care cascade.
Fig 3
Fig 3. Regional diabetes care cascade, Thailand 2014.
Point estimates are shown, with 95% confidence interval bars. Within different regions (North, Central, Northeast, South, Bangkok), people with diabetes had different rates of attrition across the care cascade. Among people with diabetes, the Northeast had the lowest rates of control (21.8%), while South had the highest rates of control (47.9%).
See this image and copyright information in PMC

References

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