AACE2021-A-1095: An Integrated Diabetes Ecosystem to Address Patient Barriers in Low-Income Communities in Philippines

Abstract

Diabetes in the Philippines is considered as a major public health concern.1 Diabetes care in the Philippines has challenges with respect to access to healthcare resources and government insurance coverage. With the national insurance system not covering comprehensive diabetes care and the private insurance companies only offering limited diabetes coverage patients mainly rely on the out-of-pocket system of healthcare for outpatient services such as laboratory procedures and daily medications. Furthermore, the high cost involved serves as a disincentive and contributes to low adherence and suboptimal care. Consequently, poor access to glycaemic monitoring and adherence to treatment impairs prevention of complications2 There is a need to improve diabetes care and its access in the Philippines to reduce overall clinical and economic burden. Aim: To evaluate an integrated diabetes care program addressing the healthcare awareness needs, screening, and accessibility of low cost medications to people living with Type 2 Diabetes(T2DM) and to also reinforce medical training in HCPs to bring better outcomes in Diabetes care. A stratified multistage sampling design was adopted for this project. Stratification was done based on the geographical distribution, population size, and socioeconomic status to provide a sample of individuals representing the Philippine population. A community-inclusive approach was taken to understand patient barriers and develop services to address those challenges. All field workers underwent intensive training before commencing field work. Pre-field activities began by seeking and obtaining approval from the local health authorities. Field activities began with mapping procedures, spreading awareness, listing of households, collection of data points like BMI, administering questionnaires, collecting FPG values, referring to health care providers, supplying of low-cost medications, etc. The program involved multi-organizational approach to provide comprehensive care, including diagnostics and monitoring devices (glucometers, strips). The program also provided insulins at 10 cents per day promise to patients ($2.5/vial) vs. significantly higher market prices. With a door-to-door delivery method, patients could save long commutes to pharmacies and hospitals. A total of 14,275 community residents were approached by field workers to spread awareness about diabetes. One thousand nine hundred and forty-two people were screened using the risk assessment questionnaire and advised for FBG tests. Out of 1,942 people who took FBG test, 1,040 (56%) had FBG <99 mg/dl, 500 (26%) had FBG between 100 – 125 mg/dl (prediabetes) and 352 (18%) had FBG >126 mg/dl (diabetes). Among the 352 patients with diabetes, 22 (6.2%) patients had an HbA1c value of > 9%. Based on the guideline recommendations, HCPs prescribed insulin to 42 patients, of which, only 12 patients adhered to treatment with the low priced insulin. The treating HCPs also underwent a comprehensive medical educational module on diabetes where the impact of program was measured with pre- and post-test questionnaire. The knowledge scores of pre- and post-training was recorded among doctors (22.5/24 vs. 20/24) and nurses (18.3/24 vs. 15.7/24). The follow up of the12 patients on insulin is under progress and the outcome data will be updated on completion of 6 months. This effort provides comprehensive data to understand how an evolving diabetes ecosystem involving awareness, screening, diagnosis, and affordable treatment (insulin) supplemented with medical education empowering HCPs can lead to better health outcomes among patients with T2DM.