Payment Methods and Patient Satisfaction among Type-2 Diabetes Patient at a Teaching Hospital in Malaysia

Diabetes mellitus is a costly chronic disease related to medication, physician consultation and laboratory investigation. The main means of financing healthcare include direct out-of-pocket (OOP) payment and government subsidisation in some countries, or public/private health insurance schemes, or a mix of all. Patient satisfaction is critical in ensuring the use of healthcare services, continuity of care and treatment adherence. In this study, we determined the satisfaction of type 2 diabetes mellitus (T2DM) patients regarding the healthcare services and payment methods at Universiti Kebangsaan Malaysia (UKM) Teaching Hospital, Malaysia. This cross-sectional study involved 313 T2DM patients aged ≥18 years who were included after clinical consultations. We used convenience sampling at the outpatient and inpatient medical centres of Hospital Canselor Tuanku Muhriz and UKM Specialist Centre. A survey consisting of sociodemographic, socioeconomic and payment method types as well as a validated patient satisfaction questionnaire scale were used. The mean age was 59.6 years (SD=13.151), 53.0% of the patients were female, 78.3% were Malay, 76.4% were uninsured, 39.6% were covered by government subsidies, while 36.7% paid OOP. Around 86% were generally satisfied with the overall services. Patients were most satisfied with technical quality (84%), communication skills (83%) and accessibility (80%), but satisfaction was lower in doctors’ service orientation, particularly the interpersonal manner (73%), financial aspect (73%) and time spent with the doctor (70%). Over 86% of patients were satisfied with healthcare services and payment methods; however, patients who paid OOP reported low satisfaction. Full insurance and extending benefits to partially cover both inpatients and outpatients with low co-payment is recommended to increase satisfaction.

Program Studi Pendidikan Jasmani, Universitas Muhammadiyah Pekajangan Pekalongan, Indonesia

Diabetes mellitus is one of the comorbidities of Covid-19 patients. This condition causes anxiety among people with Diabetes Mellitus patients. Covid-19 patients with diabetes mellitus are at high risk for experiencing more severe signs and symptom. As a result, the patient may need intensive care. To picture anxiety among people with diabetes mellitus during the COVID-19 pandemic. This literature review uses a Pubmed and Science direct database. The result of this study reveal that during COVID-19 pandemic, among diabetes patient were normal 1,167 respondents (74.3%) and based on the description of anxiety, the number of respondents who got the highest percentage, namely respondents who were not anxious, about 552 respondents (68.2%). The presence of telemedicine caused the decrease in anxiety in Diabetes mellitus patients during the pandemic. Telemedicine facilitates medical care provided remotely through audiovisual technology that provides diabetes mellitus patients during a pandemic. Telemedicine is one way to reduce anxiety in Diabetes Mellitus patients during the pandemic. So it is expected that health facilities in Indonesia can carry out telemedicine users.Keywords: Covid-19, Diabetes, Anxiety. AbstrakDiabetes Militus merupakan salah satu komorbid pasien Covid-19. Hal tersebut menyebabkan kecemasan pada pasien Diabetes Militus. Pasien Covid-19 yang memiliki Diabetes Militus beresiko mengalami tanda gejala yang lebih parah, sehingga memerlukan perawatan yang lebih intensif. Mengidentifikasi gambaran kecemasan pada penderita Diabetes Militus di masa pandemi covid-19. Desain penelitian mengunakan literature review dengan mengunakan database dengan penelusuran artikel penelitian yang publikasi di internet mengunkan PubMed dan Science direct. Gambaran tingkat kecemasan pada pasien Diabetes Militus selama Covid-19 paling banyak yaitu tidak cemas/normal 1.167 responden (74,3%) dan berdasarkan gambaran kecemasan, jumlah responden yang mendapatkan presentase paling banyak yaitu responden tidak cemas mendapatkan presentase 552 responden (86,2%). Penurunan kecemasan pada pasien Diabetes Militus pada pandemi disebabkan oleh adanya telemedicine. Telemedicine memfasilitasi perawatan medis yang diberikan dari jarak jauh melalui teknologi audiovisual yang dapat memberikan layanan bagi pasien diabetes militus selama pandemi. Telemedicine adalah salah satu cara untuk menurunkan kecemasan pada pasien Diabetes Militus pada masa pandemi. Sehingga diharapkan pengguna telemedicine dapat di lakukan oleh fasilitas kesehatan di Indonesia.Kata kunci : Covid-19, Diabetes, Kecemasan

Similarity Learning between Patients with Large Age-Gap: Model Development and Validation Study (Preprint)

BACKGROUND Similarity-based machine-learning methodologies are suitable for personalized prediction and recommendation research, which is actively applied in healthcare field along with the generalization of EHR data. In particular, the similarity learning model which carefully reflects age can be efficiently used in predicting chronic diseases, closely related to ageing. OBJECTIVE We aimed to design a similarity model for patients in different age-groups in order to predict the two major chronic diseases: Diabetes and Hypertension. METHODS We developed an idea about learning the overlapping periods of two individuals by moving the viewpoint of them to future and past respectively. From this idea, we build separated similarity learning models through three sequential age-group intervals; 30-40, 40-50, 50-60 age-groups intervals. Each model has same structure based on deep neural network. For similarity learning, we set several demographic/bi-annual check-up information and diagnosis records as input features and disease based yes-or-no similarity labels as output features. RESULTS As a result of applying hypertension patients’ pair, diabetes patients’ pair, and non-diabetes/diabetes patient pair to our methodology, the similarity value was very high, close to 1 in the former two cases, and the similarity value was low, close to zero, in the last case. This proves that similarity learning appropriately reflects the disease status between individuals. In addition, we tried to find out how the conventional single-timepoint methodology and our methodology differ in the measurement of similarity for several special cases in which the patient's disease condition changes. As a result, it was found that the similarity results between the existing methodology and our methodology differ from at least 0.2 to at most 0.9 in four special cases where the patient's condition changes. This suggests that our methodology responds more sensitively to the patient's condition changing over time and can be applied more efficiently to disease prediction in those cases. CONCLUSIONS We developed an age-sensitive similarity learning model for personalized prediction of chronic diseases targeting Koreans. As a result, for the cases that patient's disease pattern changes, by designing and learning a deep similarity learning model using divided age groups which has not been previously attempted, we have shown that similarity learning results are better than conventional single-timepoint methodology. Moreover, we proposed the possibility of overcoming data shortage limitations that occur frequently in medical datasets through a similarity learning model considering patients’ age differences.

The Charcot Foot: An Emerging Public Health Problem for African Diabetes Patients

Background: Although the awareness, diagnosis, management of the complications associated with diabetes have improved in African countries over the past decade, surveillance activities in Tanzania and anecdotal reports from other African countries have suggested an increased prevalence of Charcot Neuroarthropathy (CN) over the past few years. Aim: To characterize the epidemiology and the clinical burden of CN in a large diabetes population in Tanzania, and to evaluate outcomes of persons with the condition. Methods: This was a prospective analytic cohort study conducted between January 2013 through December 2015. Following informed consent, patients were followed at the outpatient clinic. Detailed clinical assessments and documented presence of diabetic peripheral neuropathy (DPN), macrovascular disease and microvascular disease were recorded. Education and counseling were part of the follow-up program. Results: 3271 ulcerations were presented at the clinic during the 3-year study period. 571 (18%) met the case definition for CN; all patients had Type 2 diabetes. The prevalence for each of the years 2013, 2014, and 2015 was 19/1192 (1.6%), 209/1044 (20%), and 343/1035 (34%), respectively; the increases in the slope of the trendline was statistically significant ( P < .001). Conclusion: The prevalence of CN is increasing in the Tanzanian diabetes patient population, and is strongly associated with neuropathy. CN can lead to severe deformity, disability, and amputation. Due to the risk of limb amputation, patients with diabetes must seek immediate care if signs or symptoms appear and avoid delay in seeking medical attention. Early diagnosis of CN by caregivers is extremely important for successful outcomes.

Maturity-Onset Diabetes of Young Type 5: Diabetes with Extrapancreatic Features

Objective. This case involves a new-onset diabetes patient diagnosed during pregnancy with the congenital dysplastic right kidney. Case Report. Clinical presentation, biochemical features, imaging in a patient with diabetes diagnosed during pregnancy, and congenital dysplastic right kidney. Discussion. We present a case of a 22-year-old female with the congenital dysplastic right kidney diagnosed with gestational diabetes mellitus after failing a 1-hour oral glucose tolerance test, requiring insulin during pregnancy. Because of the family history of diabetes and morphologic renal abnormalities at young ages on the maternal side of the family, our patient was evaluated for maturity-onset diabetes of adult and was found to have HNF-1β mutation. Conclusion. This case highlights the importance of considering the diagnosis of maturity-onset diabetes of young and particularly MODY-5 in individuals with extrapancreatic features. MODY-5 should also be considered in a patient undergoing renal transplant at young ages with a family history of morphologic renal abnormalities.