Forgone care in patients with type 2 diabetes: a cross-sectional study

Habib Jalilian; Somayeh Heydari; Nazanin Mir; Saeedeh Fehresti; Rahim Khodayari-Zarnaq

doi:10.1186/s12889-021-11639-2

Forgone care in patients with type 2 diabetes: a cross-sectional study

BMC Public Health. 2021 Aug 24;21(1):1588. doi: 10.1186/s12889-021-11639-2.

Authors

Habib Jalilian¹, Somayeh Heydari², Nazanin Mir³, Saeedeh Fehresti⁴, Rahim Khodayari-Zarnaq^{5

6}

Affiliations

¹ Department of Health Services Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
² Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
³ Student Research Committee, School of Management and Medical Informatics, Iran University of Medical Sciences, Tehran, Iran.
⁴ Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
⁵ Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran. rahimzarnagh@gmail.com.
⁶ Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. rahimzarnagh@gmail.com.

Abstract

Background and objective: Diabetes mellitus is a complex chronic disease requiring appropriate continuous medical care and delayed, or forgone care may exacerbate the severity of the disease. This study aimed to investigate the factors affecting forgone care in patients with type2 diabetes.

Materials and methods: This was a cross-sectional study involving 1139 patients with type 2 diabetes aged> 18 years in 2019 in Tabriz, Iran. The researcher-made questionnaire was used for data collection. Data were analyzed using IBM SPSS software version 22 and IBM AMOS 22. Exploratory Factor Analysis (EFA) was performed for dimension reduction of the questionnaire, and Confirmatory Factor Analysis (CFA) used to verify the result of EFA. We applied the binary logistic regression model to assess the factors affecting forgone care.

Results: Of the 1139 patients, 510 patients (45%) reported forgone care during the last year. The percentage of forgoing care was higher in patients without supplementary insurance coverage (P = 0.01), those with complications (P = 0.01) and those with a history of hospitalization (P = 0.006). The majority of patients (41.5%) reported that the most important reason for forgoing care is financial barriers resulting from disease treatment costs. Of the main four factors affecting, quality of care had the highest impact on forgone care at 61.28 (of 100), followed by accessibility (37.01 of 100), awareness and attitude towards disease (18.52 of 100) and social support (17.22 of 100).

Conclusion: The results showed that, despite the implementation of the Islamic Republic of Iran on a fast-track to beating non-communicable diseases (IraPEN), a considerable number of patients with type2 diabetes had a history of forgoing care, and the most important reasons for forgoing care were related to the financial pressure and dissatisfaction with the quality of care. Therefore, not only more financial support programs should be carried out, but the quality of care should be improved.

Keywords: Delayed care; Forgone care; Relinquished care; Treatment discontinuation; Treatment withdrawal; Type 2 diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Chronic Disease
Cross-Sectional Studies
Diabetes Mellitus, Type 2* / epidemiology
Diabetes Mellitus, Type 2* / therapy
Humans
Insurance Coverage
Surveys and Questionnaires