Top

International Journal of Public Health

Published in:

01-06-2018 | Original Article

eHealth as a facilitator of equitable access to primary healthcare: the case of caring for non-communicable diseases in rural and refugee settings in Lebanon

Authors: Shadi Saleh, Mohamad Alameddine, Angie Farah, Nour El Arnaout, Hani Dimassi, Carles Muntaner, Christo El Morr

Published in: International Journal of Public Health | Issue 5/2018

Abstract

Objectives

Assess the effect of selected low-cost eHealth tools on diabetes/hypertension detection and referrals rates in rural settings and refugee camps in Lebanon and explore the barriers to showing-up to scheduled appointments at Primary Healthcare Centers (PHC).

Methods

Community-based screening for diabetes and hypertension was conducted in five rural and three refugee camp PHCs using an eHealth netbook application. Remote referrals were generated based on pre-set criteria. A phone survey was subsequently conducted to assess the rate and causes of no-shows to scheduled appointments. Associations between the independent variables and the outcome of referrals were then tested.

Results

Among 3481 screened individuals, diabetes, hypertension, and comorbidity were detected in 184,356 and 113 per 1000 individuals, respectively. 37.1% of referred individuals reported not showing-up to scheduled appointments, owing to feeling better/symptoms resolved (36.9%) and having another obligation (26.1%). The knowledge of referral reasons and the employment status were significantly associated with appointment show-ups.

Conclusions

Low-cost eHealth netbook application was deemed effective in identifying new cases of NCDs and establishing appropriate referrals in underserved communities.

Amara AH, Aljunid SM (2014) Noncommunicable diseases among urban refugees and asylum-seekers in developing countries: a neglected health care need. Global Health 10:1–15. https://doi.org/10.1186/1744-8603-10-24 CrossRef

Ammar W (2009) Health reform in Lebanon key achievements at a glance. Ministry of Public Health

Anderson RM, Funnell MM (2010) Patient empowerment: myths and misconceptions. Patient Educ Couns 79:277–282CrossRefPubMed

Balcázar H, Wise S, Rosenthal EL, Ochoa C, Duarte-Gardea M, Rodriguez J, Hastings D, Flores L, Hernandez L (2012) An ecological model using promotores de salud to prevent cardiovascular disease on the US-Mexico border: the HEART project. Prev chRonic Dis 9:110100. https://doi.org/10.5888/pcd9.110100 PubMedPubMedCentral

Beaglehole R, Epping-Jordan J, Patel V, Chopra M, Ebrahim S, Kidd M, Haines A (2008) Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care. Lancet 372:940–949. https://doi.org/10.1016/S0140-6736(08)61404-X CrossRefPubMed

Chen B, Cammett M (2012) Informal politics and inequity of access to health care in Lebanon. Int J Equity health 11:1CrossRef

Gamm L, Castillo G, Pittman S (2010) Access to quality health services in rural areas—primary care. Nation 2:3

George A, Rubin G (2003) Non-attendance in general practice: a systematic review and its implications for access to primary health care. Fam Pract 20:178–184CrossRefPubMed

Gray CS, Miller D, Kuluski K, Cott C (2014) Tying eHealth tools to patient needs: exploring the use of ehealth for community-dwelling patients with complex chronic disease and disability. JMIR Res Protoc 3:e67CrossRef

Hogan TP, Wakefield B, Nazi KM, Houston TK, Weaver FM (2011) Promoting access through complementary eHealth technologies: recommendations for VA’s Home Telehealth and personal health record programs. J Gen Intern Med 26:628–635CrossRefPubMedPubMedCentral

International Diabetes Federation (2015) IDF Diabetes Atlas. IDF Diabetes Atlas—7th edn. http://www.diabetesatlas.org/. Accessed 20 May 2016

International Diabetes Federation (2017) Middle East and North Africa. http://www.idf-mena.org/about/diabetes-in-the-region. Accessed 20 May 2016

International Society of Hypertension (2015) World Hypertension Day 2015—17 May. http://ish-world.com/new-investigators-news/a/World-Hypertension-Day-2015/. Accessed 20 May 2016

Islam SMS, Tabassum R (2015) Implementation of information and communication technologies for health in Bangladesh. Bull World Health Organ 93:806–809CrossRefPubMedPubMedCentral

Islam SMS, Lechner A, Ferrari U, Froeschl G, Alam DS, Holle R, Seissler J, Niessen LW (2014) Mobile phone intervention for increasing adherence to treatment for type 2 diabetes in an urban area of Bangladesh: protocol for a randomized controlled trial. BMC Health Serv Res 14:1CrossRef

Katz SJ, Moyer CA (2004) The emerging role of online communication between patients and their providers. J Gen Intern Med 19:978–983CrossRefPubMedPubMedCentral

Khader A, Ballout G, Shahin Y, Hababeh M, Farajallah L, Zeidan W, Abu-Zayed I, Kochi A, Harries AD, Zachariah R (2014) Treatment outcomes in a cohort of Palestine refugees with diabetes mellitus followed through use of E-Health over 3 years in Jordan. Tropical Med Int Health 19:219–223CrossRef

Lacy NL, Paulman A, Reuter MD, Lovejoy B (2004) Why we don’t come: patient perceptions on no-shows. Ann Fam Med 2:541–545CrossRefPubMedPubMedCentral

Maher D, Harries AD, Zachariah R, Enarson D (2009) A global framework for action to improve the primary care response to chronic non-communicable diseases: a solution to a neglected problem. BMC Public Health 9:1CrossRef

Maher D, Ford N, Unwin N (2012) Priorities for developing countries in the global response to non-communicable diseases. Global Health 8:1CrossRef

Ministry of Public Health (2016) Non communicable diseases prevention and control plan (NCD-PCP) Lebanon 2016. Republic of Lebanon-Ministry of Public Health

Mousa H, Yousef S, Riccardo F, Zeidan W, Sabatinelli G (2010) Hyperglycaemia, hypertension and their risk factors among Palestine refugees served by UNRWA

Neal RD, Hussain-Gambles M, Allgar VL, Lawlor DA, Dempsey O (2005) Reasons for and consequences of missed appointments in general practice in the UK: questionnaire survey and prospective review of medical records. BMC Fam Prac 6:1CrossRef

Norris SL, Chowdhury FM, Van Le K, Horsley T, Brownstein JN, Zhang X, Jack L, Satterfield DW (2006) Effectiveness of community health workers in the care of persons with diabetes. Diab Med 23:544–556CrossRef

Ouma S, Herselman M (2008) E-health in rural areas: case of developing countries. Int J Biol Life Sci 4:194–200

Oyebode O, Pape UJ, Laverty AA, Lee JT, Bhan N, Millett C (2015) Rural, urban and migrant differences in non-communicable disease risk-factors in middle income countries: a cross-sectional study of WHO-SAGE data. PLoS One 10:e0122747CrossRefPubMedPubMedCentral

Paré G, Jaana M, Sicotte C (2007) Systematic review of home telemonitoring for chronic diseases: the evidence base. J Am Med Inform Assoc 14:269–277CrossRefPubMedPubMedCentral

Sabatinelli G, Pace-Shanklin S, Riccardo F, Shahin Y (2009) Palestinian refugees outside the occupied Palestinian territory. Lancet 373:1063–1065CrossRefPubMed

Samb B, Desai N, Nishtar S, Mendis S, Bekedam H, Wright A, Hsu J, Martiniuk A, Celletti F, Patel K, Adshead F, McKee M, Evans T, Alwan A, Etienne C (2010) Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries. Lancet 376:1785–1797. https://doi.org/10.1016/S0140-6736(10)61353-0 CrossRefPubMed

Serocca AB (2008) Personal health record use by patients as perceived by ambulatory care physicians in Nebraska and South Dakota: a cross-sectional study. Perspect Health Inform Manag 5:1

Sharp DJ (2001) Non-attendance at general practices and outpatient clinics: local systems are needed to address local problems. BMJ 323:1081–1083CrossRefPubMedPubMedCentral

Starfield B, Shi L, Macinko J (2005) Contribution of primary care to health systems and health. Milbank Q 83:457–502CrossRefPubMedPubMedCentral

United Nations Relief and Works Agency (2011) Palestine refugees: a special case. UNRWA Lebanon

Wakerman J, Humphreys JS (2011) Sustainable primary health care services in rural and remote areas: innovation and evidence. Aust J Rural Health 19:118–124CrossRefPubMed

Wilson N, Couper I, De Vries E, Reid S, Fish T, Marais B (2009) inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote Health 9:1060PubMed

World Health Organization (2005) Preventing chronic diseases: a vital investment, World Health Organization

World Health Organization (2015) Lebanon: WHO statistical profile, 2015. World Health Organization

Yamout R, Adib SM, Hamadeh R, Freidi A, Ammar W (2014) Peer reviewed: screening for cardiovascular risk in asymptomatic users of the primary health care network in Lebanon, 2012–2013. Prev Chronic Dis 11:E120CrossRefPubMedPubMedCentral

Youssef A (2014) Use of short message service reminders to improve attendance at an internal medicine outpatient clinic in Saudi Arabia: a randomized controlled trial/Utilisation de rappels par minimessages afin d’améliorer l’assiduité des patients dans un service de consultations externes en médecine interne en Arabie saoudite: essai contrôlé randomisé. East Mediterr Health J 20:317CrossRefPubMed

Title: eHealth as a facilitator of equitable access to primary healthcare: the case of caring for non-communicable diseases in rural and refugee settings in Lebanon
Authors: Shadi Saleh
Mohamad Alameddine
Angie Farah
Nour El Arnaout
Hani Dimassi
Carles Muntaner
Christo El Morr
Publication date: 01-06-2018
Publisher: Springer International Publishing
Published in: International Journal of Public Health / Issue 5/2018
Print ISSN: 1661-8556
Electronic ISSN: 1661-8564
DOI: https://doi.org/10.1007/s00038-018-1092-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

eHealth as a facilitator of equitable access to primary healthcare: the case of caring for non-communicable diseases in rural and refugee settings in Lebanon

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2018

Local action on outdoor air pollution to improve public health

Relationship between empowerment and wealth: trends and predictors in Kenya between 2003 and 2008–2009

Do people with intersecting identities report more high-risk alcohol use and lifetime substance use?

Health and health care access for Syrian refugees living in İstanbul

Child labour and health: a systematic review

Marked increase in measles vaccination coverage among young adults in Switzerland: a campaign or cohort effect?