scholarly journals Thailand effective coverage of diabetes and hypertension: challenges and solutions

2021 ◽  
Author(s):  
Nattadhanai Rajatanavin ◽  
Woranan Witthayapipopsakul ◽  
Vuthiphan Vongmongkol ◽  
Nithiwat Saengruang ◽  
Yaowaluk Wanwong ◽  
...  
Keyword(s):  
Supply And Demand ◽  
Patient Empowerment ◽  
Age Groups ◽  
Universal Coverage ◽  
Pharmacological Intervention ◽  
Haemoglobin A1c ◽  
Slow Increase ◽  
Effective Coverage ◽  
Disability Adjusted Life ◽  
Multi Stakeholder

AbstractBackgroundIncreased Disability Adjusted Life Year (DALY) of diabetes and hypertension draws policy attention to improve effective coverage. This study assesses effective coverage of the two conditions in Thailand between 2016 and 2019.MethodWe estimated total diabetes and hypertension cases using age and sex specific prevalence rates for respective populations. Individual data from public insurance databases (2016-2019) were retrieved to estimate three indicators: detected need (diagnosed/total estimated cases), crude coverage (received health services/total estimated cases) and effective coverage (controlled/total estimated cases). Controlled diabetes was defined as Haemoglobin A1C (HbA1C) below 7% and controlled hypertension as blood pressure below 140/90 mmHg. In-depth interview of 85 multi-stakeholder key informants was conducted to identify challenges to better effective coverage.FindingsIn 2016-2019, among Universal Coverage Scheme members residing outside Bangkok, estimated cases were around 3.1-3.2 million for diabetes and 8.7-9.2 million for hypertension. For diabetes services, all three indicators have shown slow increase over the four years (67.4%, 69.9%, 71.9%, and 74.7% for detected need; 38.7%, 43.1%, 45.1%, 49.8% for crude coverage; and 8.1%, 10.5%, 11.8%, 11.7% for effective coverage). For hypertension services, the performance was poorer for detection (48.9%, 50.3%, 51.8%, 53.3%) and crude coverage (22.3%, 24.7%, 26.5%, 29.2%) but was better for effective coverage (11.3%, 13.2%, 15.1%, 15.7%) than diabetes service. For both diseases, the estimates were higher for the females and older age groups than their counterparts. Complex interplays between supply and demand side barriers were a key challenge. Database challenges remain which hamper regular assessment of effective coverage.RecommendationsGiven the increased diabetes and hypertension prevalence, strategic recommendations cover long term actions for primary prevention of known risk factors as unhealthy diet and sedentary behaviour. Short term actions aim to improve effective coverage through the application of Chronic Care Model, increase attention to non-pharmacological intervention and patient empowerment.

scholarly journals Insight into Blood Pressure Targets for Universal Coverage of Hypertension Services in Iran: The 2017 ACC/AHA versus JNC 8 Hypertension Guidelines

2020 ◽  
Author(s):  
Mahdi Mahdavi ◽  
Mahboubeh Parsaeian ◽  
Bahram Mohajer ◽  
Mitra Modirian ◽  
Naser Ahmadi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Survey Design ◽  
Age Groups ◽  
Universal Coverage ◽  
Blood Pressure Target ◽  
Lifestyle Modifications ◽  
Treatment Rate ◽  
Blood Pressure Targets ◽  
Hypertension Guidelines ◽  
And Control

Abstract Background: We assessed and compared the prevalence, awareness, treatment, and control of hypertension in Iran under two hypertension guidelines; the 2017 ACC/AHA with an aggressive blood pressure target 130/80 mm Hg and commonly used guideline JNC8 with 140/90 mm Hg. We shed light on the implications of 2017 ACC/AHA for population subgroups and high-risk individuals eligible for non-pharmacologic and pharmacologic therapies. Methods: Data were obtained from the Iran national STEPS 2016 study. Participants included 27 738 adults ≥25 years as a representative sample of Iranians. The logistic regression models with a survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension. Results: The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) by 2017 ACC/AHA. Awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0) respectively by 2017 ACC/AHA. By new guideline, adults 25-34 years had the largest increase in prevalence (from 7.3% to 30.7%). They also had the lowest awareness and treatment rate but the highest control rate (36.5%) among age groups. Compared with JNC8, under 2017 ACC/AHA, 24%, 15%, 17%, and 11% more individuals with dyslipidaemia, high triglyceride, diabetes, and cardiovascular disease (CVD) events respectively fell into the hypertensive category. Yet, based on 2017 ACC/AHA, 68.2% of individuals falling into a hypertensive group were supposed to receive medications (versus 95.7% in JNC8). LDL cholesterol, physical activity, and one unit of Body Mass Index were found to change blood pressure by -3.56 (-4.38, -2.74), -2.04 (-2.58, -1.50), and 0.48 (0.42, 0.53) mm Hg respectively. Conclusions: Switching from JNC8 to 2017 ACC/AHA highlighted sharp increases in prevalence and drastic declines in awareness, treatment, and control in Iran. By the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category, thus might benefit from earlier interventions such as lifestyle modifications. The low control rate among treated individuals calls for a critical review of hypertension services in Iran.

scholarly journals Insight into Blood Pressure Targets for Universal Coverage of Hypertension Services in Iran: The 2017 ACC/AHA versus JNC 8 Hypertension Guidelines

2019 ◽  
Author(s):  
Mahdi Mahdavi ◽  
Mahboubeh Parsaeian ◽  
Bahram Mohajer ◽  
Mitra Modirian ◽  
Naser Ahmadi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Survey Design ◽  
Age Groups ◽  
Universal Coverage ◽  
Blood Pressure Target ◽  
Lifestyle Modifications ◽  
Treatment Rate ◽  
Blood Pressure Targets ◽  
Hypertension Guidelines ◽  
And Control

Abstract Background: We assessed and compared the prevalence, awareness, treatment, and control of hypertension in Iran under two hypertension guidelines; the 2017 ACC/AHA with an aggressive blood pressure target 130/80 mm Hg and commonly used guideline JNC8 with 140/90 mm Hg. We shed light on the implications of 2017 ACC/AHA for population subgroups and high-risk individuals eligible for non-pharmacologic and pharmacologic therapies. Methods: Data were obtained from the Iran national STEPS 2016 study. Participants included 27 738 adults ≥25 years as a representative sample of Iranians. The logistic regression models with a survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension. Results: The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) by 2017 ACC/AHA. Awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0) respectively by 2017 ACC/AHA. By new guideline, adults 25-34 years had the largest increase in prevalence (from 7.3% to 30.7%). They also had the lowest awareness and treatment rate but the highest control rate (36.5%) among age groups. Compared with JNC8, under 2017 ACC/AHA, 24%, 15%, 17%, and 11% more individuals with dyslipidaemia, high triglyceride, diabetes, and cardiovascular disease (CVD) events respectively fell into the hypertensive category. Yet, based on 2017 ACC/AHA, 68.2% of individuals falling into a hypertensive group were supposed to receive medications (versus 95.7% in JNC8). LDL cholesterol, physical activity, and one unit of Body Mass Index were found to change blood pressure by -3.56 (-4.38, -2.74), -2.04 (-2.58, -1.50), and 0.48 (0.42, 0.53) mm Hg respectively. Conclusions: Switching from JNC8 to 2017 ACC/AHA highlighted sharp increases in prevalence and drastic declines in awareness, treatment, and control in Iran. By the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category, thus might benefit from earlier interventions such as lifestyle modifications. The low control rate among treated individuals calls for a critical review of hypertension services in Iran.

scholarly journals Estimating the annual burden of tick-borne encephalitis to inform vaccination policy, Slovenia, 2009 to 2013

2017 ◽  
Vol 22 (16) ◽  
Author(s):  
Mario Fafangel ◽  
Alessandro Cassini ◽  
Edoardo Colzani ◽  
Irena Klavs ◽  
Marta Grgič Vitek ◽  
...  
Keyword(s):  
Disease Burden ◽  
Age Groups ◽  
Limited Resource ◽  
Annual Incidence ◽  
Vaccination Policy ◽  
Resource Setting ◽  
Tick Borne Encephalitis ◽  
Disability Adjusted Life ◽  
Life Years ◽  
And Control

With an annual incidence between 8 and 15 per 100,000 population in the period from 2009 to 2013, Slovenia has one of the highest notified incidences of tick-borne encephalitis (TBE) in Europe. TBE vaccination coverage remains at about 7.3%. To inform vaccination policy, we used surveillance data from 2009 to 2013 to calculate the overall and age- and sex-specific mean annual TBE incidence. We estimated disability-adjusted life years (DALYs) with 95% uncertainty intervals (UI), using the Burden of Communicable Diseases in Europe approach from the European Centre for Disease Prevention and Control. The mean annual incidence was 11.6 per 100,000 population, peaking in older age groups (50–74 years: 18.5/100,000) while relatively lower among children (5–14 years: 10.2/100,000). We estimated an overall 10.95 DALYs per 100,000 population per year (95% UI: 10.25-11.65). In contrast to the TBE incidence, the disease burden in children aged 5–14 years was higher than in adults aged 50–74 years: 17.31 (95% UI: 14.58–20.08) and 11.58 (95% UI: 10.25–12.91) DALYs per 100,000 stratum-specific population, respectively. In a limited resource setting where prioritisation of TBE vaccination strategies is required, vaccination programmes targeting children may have a higher impact on disease burden.

scholarly journals Insight into Blood Pressure Targets for Universal Coverage of Hypertension Services in Iran: The 2017 ACC/AHA versus JNC 8 Hypertension Guidelines

2020 ◽  
Author(s):  
Mahdi Mahdavi ◽  
Mahboubeh Parsaeian ◽  
Bahram Mohajer ◽  
Mitra Modirian ◽  
Naser Ahmadi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Survey Design ◽  
Age Groups ◽  
Universal Coverage ◽  
Blood Pressure Target ◽  
Lifestyle Modifications ◽  
Treatment Rate ◽  
Blood Pressure Targets ◽  
Hypertension Guidelines ◽  
And Control

Abstract Background: We assessed and compared the prevalence, awareness, treatment, and control of hypertension in Iran under two hypertension guidelines; the 2017 ACC/AHA with an aggressive blood pressure target 130/80 mm Hg and commonly used guideline JNC8 with 140/90 mm Hg. We shed light on the implications of 2017 ACC/AHA for population subgroups and high-risk individuals eligible for non-pharmacologic and pharmacologic therapies. Methods: Data were obtained from the Iran national STEPS 2016 study. Participants included 27 738 adults ≥25 years as a representative sample of Iranians. The logistic regression models with a survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension. Results: The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) by 2017 ACC/AHA. Awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0) respectively by 2017 ACC/AHA. By new guideline, adults 25-34 years had the largest increase in prevalence (from 7.3% to 30.7%). They also had the lowest awareness and treatment rate but the highest control rate (36.5%) among age groups. Compared with JNC8, under 2017 ACC/AHA, 24%, 15%, 17%, and 11% more individuals with dyslipidaemia, high triglyceride, diabetes, and cardiovascular disease (CVD) events respectively fell into the hypertensive category. Yet, based on 2017 ACC/AHA, 68.2% of individuals falling into a hypertensive group were supposed to receive medications (versus 95.7% in JNC8). LDL cholesterol, physical activity, and one unit of Body Mass Index were found to change blood pressure by -3.56 (-4.38, -2.74), -2.04 (-2.58, -1.50), and 0.48 (0.42, 0.53) mm Hg respectively. Conclusions: Switching from JNC8 to 2017 ACC/AHA highlighted sharp increases in prevalence and drastic declines in awareness, treatment, and control in Iran. By the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category, thus might benefit from earlier interventions such as lifestyle modifications. The low control rate among treated individuals calls for a critical review of hypertension services in Iran.

Keeping candles lit: The role of concierge medicine in the future of primary care

2016 ◽  
Vol 30 (2) ◽  
pp. 121-128 ◽  
Author(s):  
Rocco Palumbo
Keyword(s):  
Primary Care ◽  
Patient Engagement ◽  
Primary Care Patient ◽  
Evidence Synthesis ◽  
Patient Empowerment ◽  
Universal Coverage ◽  
Care Patient ◽  
Care Practice ◽  
Access To Primary Care ◽  
Primary Care Practices

Universal coverage and financial sustainability are two competing aims in primary care. Patient empowerment and patient engagement have been suggested as essential ingredients of the recipe for innovative primary care models aimed at sustaining universal coverage. Concierge medicine is achieving a growing popularity among both scholars and practitioners as a direct primary care practice which allows to bridge the gap between patient empowerment and patient engagement. However, ethical and legal concerns hinder the diffusion of concierge models in the current primary care practices. This manuscript is aimed at providing an evidence synthesis of extant contributions in the field of concierge medicine in order to discuss its attributes and to examine its expected effects on universal coverage and sustainability. For this purpose, a systematic literature review involving 29 manuscripts was performed. The findings of this study pointed out that concierge models could play a significant role in enhancing the access to primary care and in improving the sustainability of the healthcare service system. However, the existing institutional arrangements which regulate the access to primary care should be revised to allow more spaces for the implementation of concierge practices.

scholarly journals The Burden of Stroke in The Municipality of Chongqing, China, From 1990 To 2016

2020 ◽  
Author(s):  
Shiya Yang ◽  
Sha Ran ◽  
Ping Liu ◽  
Zuocheng Wu ◽  
Dong Yu ◽  
...  
Keyword(s):  
Temporal Trends ◽  
Age Groups ◽  
Health Resources ◽  
Mortality Rates ◽  
Western China ◽  
Years Of Life Lost ◽  
Prevalence Rates ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Disease Study

Abstract Background: The burden of stroke varies substantially across regions in China. However, comprehensive comparisons between regions are lacking. This study aims to analyze variations in stroke burden in the municipality of Chongqing, Western China, from 1990-2016. Methods: Data on prevalence, years lived with disability (YLDs), mortality, years of life lost (YLLs), and disability-adjusted life years (DALYs) by age, sex, location, and year were extracted from the 2016 Global Burden of Disease Study (GBD 2016) of China between 1990-2016. The datasets were compared to examine the temporal trends in stroke burden in the last two decades.Results: In 2016, there were 670,438 cases of stroke, 41,022 deaths, and 847,437 DALYs due to stroke in Chongqing. Age-standardized mortality and DALY rates of IS and HS were higher in men whereas age-standardized prevalence rates of IS were higher in women. From 1990 to 2016, age-standardized prevalence rates of overall stroke increased by 33.29%, whereas mortality rates and DALYs decreased by 34.51% and 34.79%, respectively. YLLs were the main contributor to DALYs; however, the YLL/YLD ratio decreased over time. During the study period, the overall burden of stroke decreased, whereas the prevalence rate of IS increased in all age groups.Conclusions: Despite a decrease in mortality rates, the increase in the prevalence of stroke in Chongqing stresses the need to allocate more health resources. Special attention should be paid to discrepancies in the estimation of the type of stroke according to gender and age to determine mechanisms that explain the causes of stroke.

scholarly journals Estimation of economic burden of COVID-19 using Disability-Adjusted Life Years (DALYs) and Productivity Losses in Kerala state, India

2020 ◽  
Author(s):  
Denny John ◽  
Narassima MS ◽  
Jaideep C Menon ◽  
Guru Rajesh Jammy
Keyword(s):  
Global Economy ◽  
Age Groups ◽  
Premature Mortality ◽  
Baseline Scenario ◽  
Disability Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Males And Females ◽  
Kerala State ◽  
The Impact

Abstract Background: The COVID-19 pandemic has had a huge impact on the global economy and stressed the health care systems worldwide. Measuring the burden of disease on health and economy is essential for system preparedness by way of allocation of funds and human resources.Methods: The present study estimates Disability-Adjusted Life Years (DALYs), Years of Potential Productive Life Lost (YPPLL) and Cost of Productivity Lost (CPL) due to premature mortality and absenteeism, secondary to COVID-19 in Kerala state, India. The impact of disease on various age-gender cohorts has been analyzed. Sensitivity Analysis has been conducted by adjusting six variables with a total of 21 scenarios. Results: Severity of infection and mortality were higher among older sub-group of patients, and male were more susceptible than female in most of the age groups. DALY for the baseline scenario was 15,924.24 and 8,669.32 for males and females respectively. The CPL due to premature mortality was 26,80,36,179 and 42,510,946 for males and females respectively. Conclusion: People aged more than 50 were disproportionately affected by the disease, with presence of comorbidities further raising vulnerability.

The trend of incidence and burden of neurological disease in Iran between 1990 and 2017: Based on global burden of disease estimations

2019 ◽  
Author(s):  
Hedayat Abbastabar ◽  
Sama Bitarafan ◽  
Mohammad Hossein Harirchian
Keyword(s):  
Burden Of Disease ◽  
Neurological Disease ◽  
Neurological Diseases ◽  
Age Groups ◽  
Global Burden Of Disease ◽  
Global Burden ◽  
Disability Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Increasing Trend

Neurological disease contributes significantly to morbidity and mortality in different ages and geographic areas around the world. The purpose of the current study was to investigate the incidence and disability-adjusted life years (DALYs) trend of neurological disease in Iran during 27 years ago. We used the data of the Global Burden of Disease (GBD) Study to estimate the incidence and DALYs of neurological disease in Iran in different age groups between 1990 and 2017. Age groups were defined in 5 groups including < 5 years, 5-14 years, 15-49 years, 50-69 years, and ≥ 70 years. The incidence number of neurological disease during 1990 to 2017 increased from 7.5 million to more than 12 million and the incidence rate grew as much as 1400 per 100000 populations in Iran. Totally, headache, epilepsy, and Alzheimer were the most common neurological diseases according to incidence and had the most values of DALY in Iran. The highest incidence and DALY of neurological disease was observed in the age group of 15-49 years. This study showed that the incidence and burden of neurological diseases had a dramatic increasing trend during 27 years ago in Iran. Consequently, it is necessary to investigate the causes of the growing trend in future studies. 

scholarly journals Toward universal coverage in Afghanistan: A multi-stakeholder assessment of capacity investments in the community health worker system

2015 ◽  
Vol 145 ◽  
pp. 173-183 ◽  
Author(s):  
Anbrasi Edward ◽  
Casey Branchini ◽  
Iain Aitken ◽  
Melissa Roach ◽  
Kojo Osei-Bonsu ◽  
...  
Keyword(s):  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Universal Coverage ◽  
Multi Stakeholder

Burden of Epilepsy in Colombia

2015 ◽  
Vol 44 (3) ◽  
pp. 144-148 ◽  
Author(s):  
Alejandro Méndez-Ayala ◽  
Daniel Nariño ◽  
Diego Rosselli
Keyword(s):  
Disease Duration ◽  
Disease Incidence ◽  
Age Groups ◽  
Premature Mortality ◽  
Attributable Mortality ◽  
Death Certificates ◽  
Disability Adjusted Life Years ◽  
Healthcare Provision ◽  
Disability Adjusted Life ◽  
Life Years

Background: Epilepsy lays an important burden on healthcare systems and society in general. Disability adjusted life years (DALYs) have been developed to compare the burden of this disease both between conditions and between geographical boundaries. With improving data on disease incidence and prevalence in Colombia, we can refine our DALYs-based estimates. Methods: Using different strategies, including the official healthcare provision database and death certificates, as well as extrapolation from published neuroepidemiologic studies, we estimated the incidence and prevalence by age groups, disease duration and attributable mortality. With this information we calculated DALYs for the year 2012. Results: Overall, it was found that epilepsy was responsible for 0.88% of all deaths in Colombia. A total of 5.25 DALYs per 1,000 person-years are lost due to epilepsy in Colombia, 75% of which (3.91 DALYs) are due to premature mortality, with a higher burden in men (6.12 DALYs) than in women (4.41 DALYs). Conclusions: We reported new estimations on epilepsy incidence and prevalence by age groups in Colombia and conclude that DALYs lost due to epilepsy in Colombia are almost double the previous figure, mostly because of the underestimation of attributable mortality. With this figure, epilepsy ranks 12th instead of 19th in the list of the most important causes of DALYs lost.

Sign in / Sign up

Export Citation Format

Share Document