Conectar
by Saydeh Dableh, Kate Frazer, Mathilde Azar, Randa Hamadeh, Thilo Kroll
IntroductionOlder people in low- and middle-income countries face significant challenges when accessing primary care services. In Lebanon, most older people (75%) living with at least one chronic disease previously accessed private health services for care. However, the economic crisis substantially increased their reliance on primary healthcare centers (PHCCs), while factors shaping access to public services were unknown. This study explores the barriers and enablers influencing access to PHCCs’ services.
MethodsThis descriptive qualitative study involved 57 people including older adults (aged 60–92 years), informal caregivers, and service providers, recruited using maximum variation sampling. Data were collected through seven focus groups and fifteen interviews. The Framework Method was adopted for thematic analysis. The Patient-centered Access to Healthcare Framework facilitated mapping of barriers and enablers across five access opportunities.
ResultsFindings are presented under five themes: 1) perception of healthcare needs, enabled by acute symptoms, free services, literacy, and familial support but hindered by lack of information on services; 2) healthcare seeking, supported by respectful providers, familial support, available quality services, and positive leadership, but constrained by providers’ attitudes, poor service organization, limited finances, and negative perceptions; 3) healthcare reaching, enabled by proximity of PHCCs and home care, but limited by transport issues, mobility restrictions, staff and resource shortages, and service delivery challenges; 4) healthcare utilization, facilitated by low fees and economic recession, but hindered by lack of funds and financial resources; and 5) healthcare consequences, facilitated through positive relationships, literacy, and personal abilities, but constrained by cognitive and sensory limitations, poor relationships, and lack of care continuity, coordination, comprehensiveness, and patient-centeredness.
ConclusionsThis study highlights the challenges for older people, indicating factors to be strengthened and barriers requiring action at the PHCC and multi-sectoral levels. Ensuring adequate funding, information, and health coverage is primordial to improve older people’s access to PHCCs.
To describe the prevalence of cardiovascular disease (CVD) at the time of diagnosis of adult-onset type 1 (T1D) and type 2 (T2D) diabetes, in a recent cohort and compare to a previous cohort from the same region. Further, to explore factors influencing the prevalence of pre-existing CVD, including age, sex, body mass index (BMI) and C-peptide; in the later cohort also heart failure, hyperlipidaemia, tobacco use and physical activity.
Two prospective cross-sectional cohort studies compared.
All primary health care centres and hospitals in Kalmar and Kronoberg counties in Southeastern Sweden.
Adults with newly diagnosed T1D or T2D (classified by combination of islet antibodies and C-peptide) in 1998–2001 and 2016–2017.
Prevalence of hypertension and CVD at diagnosis of diabetes, and associations with beta-cell function, in two cohorts collected 15 years apart. Further, to explore factors influencing the prevalence of hypertension and CVD, and level of C-peptide.
In patients with newly diagnosed T2D, mean age-at-onset had decreased (66±14.1 years vs 63±12.6, p≤0.001) and mean BMI had increased (29.0±5.4 vs 31.4±5.8 kg/m2, p≤0.001). Prevalence of pre-existing myocardial infarction had decreased in both T1D (18% vs 7%, p=0.03) and T2D (25% vs 11%, p≤0.001). Pre-existing hypertension had increased in both T1D (23% vs 40%, p=0.01) and T2D (44% vs 61%, p≤0.001). C-peptide level was lower and was associated with several cardiovascular conditions in newly diagnosed T2D in 2016–2017 (p=0.048 p≤0.001).
Patients with newly diagnosed T2D were younger, with higher BMI, compared with 15 years earlier, a challenge for diabetes care. Prevalence of pre-existing myocardial infarction had decreased notably, in line with, but still less than in the general population; while pre-existing hypertension had increased, in both diabetes types. C-peptide was associated with several cardiovascular conditions in newly diagnosed T2D in the recent cohort, which warrants further investigation.
FreshRSS 