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Title: Assessing the influence of health systems on type 2 diabetes mellitus awareness, treatment, adherence, and control: A systematic review
Authors: Ong S.E. 
Kai Koh J.J. 
Toh S.-A.E.S. 
Chia K.S. 
Balabanova D.
McKee M.
Perel P.
Legido-Quigley H. 
Keywords: attitude to illness
cost benefit analysis
diabetes control
education program
geographic distribution
health auxiliary
health care
health care access
health care delivery
health care financing
health care management
health care policy
health care quality
health care utilization
health impact assessment
health insurance
low income country
medication compliance
middle income country
non insulin dependent diabetes mellitus
patient care
patient compliance
peer group
program evaluation
qualitative analysis
risk assessment
self monitoring
systematic review
therapy effect
treatment outcome
treatment response
attitude to health
global health
health care organization
health care planning
health care policy
health service
non insulin dependent diabetes mellitus
Delivery of Health Care
Diabetes Mellitus, Type 2
Global Health
Health Knowledge, Attitudes, Practice
Health Policy
Health Services
Health Systems Agencies
Health Systems Plans
Issue Date: 2018
Publisher: Public Library of Science
Citation: Ong S.E., Kai Koh J.J., Toh S.-A.E.S., Chia K.S., Balabanova D., McKee M., Perel P., Legido-Quigley H. (2018). Assessing the influence of health systems on type 2 diabetes mellitus awareness, treatment, adherence, and control: A systematic review. PLoS ONE 13 (3) : e0195086. ScholarBank@NUS Repository.
Abstract: Background Type 2 Diabetes Mellitus (T2DM) is reported to affect one in 11 adults worldwide, with over 80% of T2DM patients residing in low-to-middle-income countries. Health systems play an integral role in responding to this increasing global prevalence, and are key to ensuring effective diabetes management. We conducted a systematic review to examine the health system-level factors influencing T2DM awareness, treatment, adherence, and control. Methods and findings A protocol for this study was published on the PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016048185). Studies included in this review reported the effects of health systems factors, interventions, policies, or programmes on T2DM control, awareness, treatment, and adherence. The following databases were searched on 22 February 2017: Medline, Embase, Global health, LILACS, Africa-Wide, IMSEAR, IMEMR, and WPRIM. There were no restrictions on date, language, or study designs. Two reviewers independently screened studies for eligibility, extracted the data, and screened for risk of bias. Thereafter, we performed a narrative synthesis. A meta-analysis was not conducted due to methodological heterogeneity across different aspects of included studies. 93 studies were included for qualitative synthesis; 7 were conducted in LMICs. Through this review, we found two key health system barriers to effective T2DM care and management: financial constraints faced by the patient and limited access to health services and medication. We also found three health system factors that facilitate effective T2DM care and management: the use of innovative care models, increased pharmacist involvement in care delivery, and education programmes led by healthcare professionals. Conclusions This review points to the importance of reducing, or possibly eliminating, out-of-pocket costs for diabetes medication and self-monitoring supplies. It also points to the potential of adopting more innovative and integrated models of care, and the value of task-sharing of care with pharmacists. More studies which identify the effect of health system arrangements on various outcomes, particularly awareness, are needed. © 2018 Ong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Source Title: PLoS ONE
ISSN: 19326203
DOI: 10.1371/journal.pone.0195086
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