Reasons for low utilisation of public facilities among households with hypertension: analysis of a population-based survey in India
Reasons for low utilisation of public facilities among households with hypertension: analysis of a population-based survey in India
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DOI：
10.1136/bmjgh-2018-001002
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发表时间：
2018-11-01
影响因子：
8.1
通讯作者：
Kruk, Margaret E.
中科院分区：
文献类型：
--
作者：
Kujawski, Stephanie A.;Leslie, Hannah H.;Kruk, Margaret E.
简介 在印度，对于大多数患者来说，初级医疗保健仍然是管理非传染性疾病风险因素的预期切入点。高血压家庭不利用公共初级保健的程度和决定因素尚未得到充分研究。我们探讨了印度 21 个邦和中央直辖区的卫生设施利用模式以及不使用公共设施的原因，重点关注高血压。方法我们使用了 2012-2013 年地区级家庭和设施调查的数据。我们检查了所有家庭、患有高血压的家庭以及患有高血压和糖尿病的家庭的自我报告的常用护理来源，以了解高血压患者的多重发病率。高血压的定义是自我报告的诊断或测量收缩压≥140毫米汞柱或舒张压≥90毫米汞柱。糖尿病的定义是自我报告的诊断或空腹血糖水平≥7.0mmol/L或非空腹血糖水平≥11.1mmol/L。我们评估了仅患有高血压和高血压合并糖尿病的家庭的设施使用选择和不使用公共设施的原因。 结果 在 336 305 户家庭中，37.6%（N=126 597）至少有一名家庭成员患有高血压，而 15.9%（N=53 385）家庭成员患有高血压和糖尿病。 20.0%的家庭在公立初级诊所寻求医疗服务，29.9%的家庭在公立医院寻求医疗服务，48.3%的家庭在私人机构寻求医疗服务。随着疾病负担的增加，私人设施的选择也随之增加。仅患有高血压以及高血压和糖尿病的家庭比没有高血压的家庭更多地提到不使用公共设施的质量原因。 结论 家庭，特别是患有高血压的家庭，在日常护理中选择私人设施而不是公共设施。护理质量是高血压和糖尿病家庭选择设施的重要决定因素。随着印度高血压和心血管疾病的增加，必须解决公共初级医疗保健的质量问题，以使当前政策成为现实。
Introduction In 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.Methods We 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.Results In 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.Conclusion Households, 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.