Mối liên quan giữa Bệnh không lây với dịch vụ sức khỏe và các rào cản do xã hội ở người trung niên_ NCD related health services use and barrier differences by social locations of middle aged people in lao PDR

NCD related Health Services Use and Barrier Dif
erences by Social Locations of Middle Aged peop
le in Lao PDR
Gunjeong Lee, Kongmany Chaleunvong, Younhee Kang, Minah Kang, Harris Hyun-soo Kim, Kyungok Yi, Yuri Kim, Yookyung
Choi, Minjin Koo

September 26th- 27th , 2015

Gunjeong Lee, Ph.D.
Department of Global Health and Nursing, Ewha Womans University, Seoul, Ko
rea


Background



Non-communicable diseases (NCD) are on the rise to become one of the major cause of
morbidity and mortality of the people in Lao PDR.



Due to NCD’s deep impacts on economic and social burden, the importance of preventi
on and management of NCDs has been acknowledged widely.


Background



Limited researches on the need of NCD related health service use, the status of health se

rvice utilization, and barriers of service use.



This study analyzed the need, the use, and the barriers of NCD related health services in
relation of respondents’ social location.


Aims
1.

To examine the need of NCD related health service use

2.

To find out the methods and quantity of health service utilization

3.

To understand the barriers of needed health service use

4.

To investigate the differences of health service use by “social location”, such as gender,
age, financial status, and residential place.


Methods


Survey Study

 Research Object : Middle aged people (40-59 years old)
 Period : May 2th – June 3th, 2015
 Randomly selected 25 urban villages in 2 district from Vientiane Capital and 25 rural vill
ages in 2 district from Vientiane Province.



Random selected 20 households from each village’s household list

 Interviewed one member who is 40-59 years old
 N=997 completed
 removed 17 due to inappropriate or incomplete answers
 Final N=979


Methods


Variables for this study

 health service utilization
 barriers of health service use
 social locations such as gender, residential area, age, etc.
 current health status and knowledge level of health

 Statistical Analysis
 Descriptive statistical methods and subgroup analyses by social location

Measure of NCD
Definition of NCD:
Diagnosed by Medical Doctor having Hypertension, Diabetes, Mellitus, Heart Disease,
Cerebro-vascualr Disease, or Cancer

Number (N)

Percent (%)

Diagnosed NCD

250

25.54%

No NCD

682

69.66%

Don’t know

47

4.80%

Total N

979

100%


Diagnosed NCD

Diagnosed NCD

N (Total N=250)

%

Hypertension

192

76.8%

Diabetes Mellitus

63

25.2%

52

20.8%

Cerebrovascular Disease (Stroke)

6

2.4%

Cancer

2

0.8%

Heart Disease
(Angina, Myocardial infarction, Heart rhythm problem,
etc.)

25people (10%) have more than one diagnosed NCDs


Diagnosed NCD
variable

NCD

No NCD

Don’ know

All

25.54%

69.66%

4.80%

Male (n=435)

21.38%

73.10%

5.52%

Female (n=544)

28.86%

66.91%

4.23%

40-49yr (n=510)

21.76%

74.51%

3.73%

50-59yr (n=469)

29.64%

64.39%

5.97%

Rural

25.66%

68.64%

5.70%

Urban

25.41%

70.70%

3.89%

Lao-tai

26.68%

69.42%

3.90%

Hmong-mien

16.05%

71.60%

12.35%

Others

22.45%

69.39%

8.16%

< primary

31.25%

57.95%

10.80%

Primary~ secondary shool

23.46%

73.46%

3.07%

≥ upper secondary school

25.58%

70.35%

4.07%

Literate

24.74%

71.31%

3.95%

Illiterate

31.36%

57.63%

11.02%

Unhealthy

37.62%

57.71%

4.67%

Healthy

16.15%

78.95%

4.90%

Employee

23.45%

71.72%

4.83%

Self-employee

25.83%

69.03%

5.14%

Others(Unemployed)

26.16%

70.35%

3.49%

(N=979)

sex

Age

Area

Ethnic-group

Education level

Literacy

0.024

0.002

0.402

0.003

0.000

0.000

Health status

Work status

P-value

0.000

0.877


Usual place for treatment
Variable

N

Total

Drug
Store

Clinic

Hospital

Community

Village

No

Health

Health

Place

Center

Volunteer

To go

Others

979

11.13%

13.59%

68.64%

2.25%

0.61%

1.33%

2.45%

NCD

250

7.20%

20.80%

68.40%

2.00%

0.00%

0.00%

1.60%

No NCD

682

11.00%

10.70%

70.97%

1.91%

0.88%

1.61%

2.93%

Male

435

14.48%

12.87%

64.83%

3.22%

0.23%

1.38%

2.99%

Female

544

8.46%

14.15%

71.69%

1.47%

0.92%

1.29%

2.02%

40-49

510

12.35%

13.92%

64.71%

3.33%

1.18%

1.57%

2.94%

50-59

469

9.81%

13.22%

72.92%

1.07%

0.00%

1.57%

2.94%

Lao-tai

847

10.51%

13.93%

69.89%

1.30%

0.71%

0.94%

2.72%

Hmong- Mien

81

17.28%

12.35%

56.79%

8.64%

0.00%

3.70%

1.23%

Others

49

8.16%

10.20%

69.39%

8.16%

0.00%

4.08%

0.00%

< Primary

176

15.91%

12.50%

63.64%

2.84%

0.57%

3.41%

1.14%

Primary- lower secondary

456

8.99%

13.38%

70.39%

2.85%

0.88%

1.10%

2.41%

≧ upper secondary

344

11.34%

14.53%

69.19%

1.16%

0.00%

0/58%

3.20%

Literacy

861

10.22%

14.05 %

69.57%

1.97%

0.46%

1.05%

2.67%

Illiteracy

118

17.80%

14.05 %

61.86%

4.24%

1.69%

3.99%

0.85%

Employee

115

8.28%

13.10%

75.86%

0.00%

0.69%

0.00%

2.07%

self-employee

662

12.24%

14.80%

65.56%

2.87%

0.60%

1.51%

2.42%

Unemployed

172

9.30%

9.30%

74.42%

1.74%

0.58%

1.74%

2.91%

Health

Unhealthy

428

10.98%

15.89%

67.99%

2.34%

0.47%

0.70%

1.64%

Status

Healthy

551

11.25%

11.80%

69.15%

2.18%

0.73%

1.81%

3.09%

NCD

P-value

0.000

Sex

0.014

Age

Ethnic
group

Education

0.011

Literacy

Work

0.000

0.0039

0.006

0.221

Status

0.266


Difficulty in getting medical care
Experience of difficulty in getting medical care
Yes

97

(9.92%)

No

882

(10.08%)

Reasons of Difficulty to get medical care
2
5
56
2
42


Health Service Use (during last 1yr)

Health Service

Total

NCD

No NCD

(N=979, % )

(N=250)

(N=682)

know

P-value

(N=47)

In-Patient

73

7.46%

13.6%

5.4%

4.3%

0.000

Emergency room

85

8.68%

12.8%

7.3%

6.4%

0.027

Out patient

208

21.25%

31.6%

18.2%

10.6%

0.000

Community health center

35

3.58%

6.4%

2.5%

4.3%

0.016

26

2.66%

3.2%

2.6%

0.0%

0.456

Traditional healer

77

7.87%

12.8%

6.6%

0.0%

0.001

Dental care

179

18.32%

18.8%

19.0%

6.4%

0.095

Village health care volunteer

Significant differences by subgroup analyses, more use on

•
•
•
•
•
•
•

Don’t

In-patient : Age(50-59 years old)
Emergency room : Sex(Female), Area(Urban)
Out-patient experiences b: Sex(Female)
Community health center services : Area(Rural)
Village health care volunteer(or worker) : Sex(Female), Age(40-49 years old), Area(Rural)
Traditional healer : Area(Rural)
Dental care : Sex(Female), Area(Urban)


Drug store use during last month

Total

NCD

No NCD

Don’t know

(N=979)

(n=250)

(n=682)

(n=47)

1-2 times per 1 month

30.75%

34.00%

29.47%

31.91%

Over 3 times per 1mon

17.77%

26.00%

14.96%

14.89%

Not used

51.48%

40.00%

55.57%

53.19%

Frequency of Drug store Use

Significant difference by subgroup analyses, more use for

•
•

Area -rural
Health status- Unhealthy

P-value

0.000


Medical insurance

Having insurance

All

NCD

No NCD

Don’t know

(N=979)

(n=250)

(n=682)

(n=47)

25.23%

29.72%

29.23%

17.02%

P-value

0.088
No Insurance

74.77%

70.28%

70.77%

80.98%

Among Having insurance

N=246

100%

Public Insurance

235

95.5%

Private Insurance

12

4.5%


Information about NCD

Total
N=979

NCD

No NCD

Don’t know

P

100%

(n=250)

(n=50)

(n=47)

-value

Received information

410

41.88%

64.40%

34.90%

23.40%

Not received information

527

53.8%

35.60%

78.13%

74.47%

Don’t know

2

0.2%

0.00%

50.00%

2.13%

Received Information about?

Hypertension

Diabetes mellitus

Both

404 (41.27%)

340 (34.73%)

331 (33.81%)

0.000


Medical check up

Total
NCD

No NCD

(n=250)

(n=682)

Don’t
know
(n=47)

N

%

 Regular check up

277

28.3%

39.60%

25.07%

14.89%

Irregular check up

343

35.0%

49.60%

34.02%

25.53%

No medical check up

359

36.7%

20.80%

40.91%

59.57%

Pvalue

P<0.001


Logistic regression analysis
on Getting Regular Medical check up

Among NCD

Independent variable

OR (95% CI)

Among Non NCD

p-value

OR (95% CI)

p-value

Male

1.56 (0.79-3.06)

0.192

1.29 (0.93-1.78)

0.124

age

0.98 (0.93-1.04)

0.571

0.99 (0.14-2.05)

0.692

rural

0.51 (0.24-1.05)

0.067

0.89 (0.64-1.23)

0.473

2.67 (0.69-10.29)

0.154

2.44 (1.35-4.43)

0.003

Less than primary school

0.95 (0.30-2.99)

0.933

1.31 (0.76-2.25)

0.338

Illiteracy

1.27 (0.36-4.47)

0.706

1.92 (1.02-3.64)

0.043

Unhealthy

1.66 (0.86-3.20)

0.134

1.46 (1.05-2.02)

0.025

Unemployed

0.98 (0.93-1.04)

0.571

0.99 (0.14-2.05)

0.692

Hmong-mien


Difficulty in getting medical care

Total
NCD

No NCD

(n=250)

(n=682)

Don’t
know
(n=47)

N

%

Yes

96

28.3%

12.85%

8.06%

19.15%

No

877

35.0%

87.15%

91.20%

80.85%

Don’t Know

5

36.7%

0.00%

0.73%

0.00%

Pvalue

0.021


Logistic regression analysis
on difficulty in getting medical care
Among NCD

Independent variable

OR (95% CI)

Among Non NCD

p-value

OR (95% CI)

p-value

Male

0.38 (1.43-0.99)

0.047

0.84 (0.44-1.61)

0.606

age

1.00 (0.94-1.08)

0.886

0.96 (0.92-1.01)

0.139

rural

1.53 (0.65-3.57)

0.328

1.96 (0.99-3.85)

0.052

Hmong-mien

0.51 (0.63-3.57)

0.548

2.93 (1.23-7.01)

0.015

Less than primary school

0.63 (0.19-2.13)

0.456

1.59 (0.61-4.15)

0.340

Illiteracy

2.31 (0.64-8.32)

0.199

0.72 (0.24-2.19)

0.570

Unhealthy

1.39 (0.59-3.25)

0.449

3.76 (2.03-6.95)

0.000

Unemployed

0.98 (3.46-2.76)

0.964

1.49 (0.70-3.12)

0.296


Results


There were significant differences of NCD diagnose rate between sex group, age grou
p, ethnic group, education



NCD diagnosis, sex, age, ethnic group, education level
differences on usual



level, literacy or not and health status.
and literacy made significant

treatment place.

The highest two main reason on difficulty in getting

medical care were ‘cost’ an

d ‘transportation’.



NCD diagnosis made an significant differences on health service use in last 1 year suc
h as in-patient experience, emergency room use, out-patient experience, community
health care center use and traditional healer use.


Results


NCD diagnosis made an significant differences on Drug store use in last 30 days. Also,
area and health status

made such significant differences.



NCD diagnosis made an significant differences on



Hmong mien, the more illiterate, the more unhealthy and the more unemployed, the h

Information about NCD.

igher the rate of ‘no medical check up’.



Male, Hmong mien, the more unhealthy and the more
ate of ‘Experience of

unemployed, the higher the r

difficulty in getting medical care’.


Conclusion


By this survey, the gaps of medical service need and health service use are not big.



However, more researches are needed on the meaning of medical diagnosis, health serv
ice use, medical check-up, due to the low level of using medical facilities and

kn

owledge on NCDs.



There are significant differences on NCD related health

cial locations. Therefore

service use and barriers by so

political intervention is needed to improve health service a

ccessibility and affordability for the group with unmet

health service need.


References
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Medicine, 5(181), 181cm184. doi: 10.1126/scitranslmed.3005121.

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