Table 6.
Main findings of studies included in this review, presented based on the determinants of access to medication among diabetic patients
| Determinants | Authors | Country (years) | Study design | Main findings |
|---|---|---|---|---|
| Place of residence | Ben Romdhane et al. | Tunisia (2014) | Quantitative | The proportion of those who were aware of having diabetes and untreated in urban and rural areas was 11.9 and 11%, respectively (p>0.05). |
| Cunningham-Myrie et al. | Jamaica (2013) | Quantitative | 94.2% of people with diabetes in rural areas were treated, compared to 93.8% in urban areas | |
| Balabanova et al. | Georgia (2008) | Qualitative | Access to insulin was a problem in rural areas. | |
| Kolling et al. | Tanzania (2010) | Qualitative | Access to diagnosis and treatment was a problem in rural areas. | |
| Kühlbrandt et al. | Armenia, Belarus, Moldova, and Ukraine (2014) | Qualitative | Patients in rural areas were disadvantaged in accessing health facilities for screening and treatment by medical professional. | |
| Rutebenberwa et al. | Uganda (2013) | Qualitative | Patients who had geographical barrier to access health facilities substitute their medication with herbal medication. | |
| Racial/ethnic | Le et al. | Yunan, China (2011) | Quantitative | The minority ethnic group had lower probability to be treated compared to Han (OR=0.26; 95% CI=0.09; 0.73). |
| Chary et al. | Guatemala (2012) | Qualitative | In general, indigenous workers received lower payment than other workers. This affected their ability to buy medication for treating DM. | |
| Occupation | Ben Romdhane et al. | Tunisia (2014) | Quantitative | There is no significant association between type of occupation and probability for being untreated. |
| Gender | Ben Romdhane et al. | Tunisia (2014) | Quantitative | 13% of women were untreated compared to 9.6% of men. |
| Stephens et al. | 15 LMICs (2013) | Quantitative | In Brazil, use of newer drugs were more prevalent for men than women (p<0.01). | |
| Cunningham-Myrie et al. | Jamaica (2013) | Quantitative | There were more women who were treated (95%) compared to men (90.5%). | |
| Gakidou et al. | Colombia (2007) | Quantitative | 16.7% of women and 10% of men who had diabetes were untreated. | |
| Iran (2004) | Quantitative | 11.5% of women and 12.5% of men who had diabetes were untreated. | ||
| Mexico (1994) | Quantitative | 2% of women and 4.7% of men who had diabetes were untreated. | ||
| Thailand (2008) | Quantitative | 3.2% of women and 8.1% of men who had diabetes were untreated. | ||
| Le et al. | Yunan, China (2011) | Quantitative | 17.2% of men and 26.3% of women who had diabetes were treated. | |
| Bhojani et al. | India (2013) | Qualitative | Domestic roles had restricted women’s access to find medical treatment. | |
| Religion | No studies include religion as determinant of access to diabetes medication | |||
| Education | Ben Romdhane et al. | Tunisia (2014) | Quantitative | There is no significant association between level of education and being untreated. |
| Cunningham-Myrie et al. | Jamaica (2013) | Quantitative | There was no significant association between level of education and being treated. | |
| Le et al. | Yunan, China (2011) | Quantitative | Patients who had primary (OR 2.91; 95% CI=1.69; 4.86) and middle/higher education (OR=2.72; 95% CI=1.22; 4.03) had higher probability to be treated with any DM medication compared to illiterate patients. | |
| Socio-economic status/income | Ben Romdhane et al. | Tunisia (2014) | Quantitative | There are no significant association quintiles of household wealth and being untreated. |
| Baumann et al. | Uganda (2010) | Quantitative | 37.9% had missed medication because they could not afford it. | |
| Cunningham-Myrie et al. | Jamaica (2013) | Quantitative | The proportion of people being treated was higher for higher-level income (100%) compared to those with middle-level (92.1%) and lower-level income (91.9%), p>0.05. | |
| Le et al. | Yunan, China (2011) | Quantitative | Those who were categorised as high-income group had higher probability than those in the low-income group (OR=2.92; 95% CI=1.64; 5.57). | |
| Bhojani et al. | India (2013) | Qualitative | Financial hardships affected people’s access to DM medication. Some of patients reduced their medication dosage or mixed with traditional medication to reduce medication cost. | |
| Chary et al. | Guatemala (2012) | Qualitative | Among the poor patients, cost of medication is a major barrier for being treated. Some of them bought the prescribed medication only when the household income allowed. | |
| Higuchi | The Philippines (2010) | Qualitative | Patients expressed financial constraint as major barriers to access or continue DM medication. | |
| Balabanova et al. | Georgia (2008) | Qualitative | Out-of-pocket payments for insulin acted as a significant barrier to access DM medication. | |
| Kolling et al. | Tanzania (2010) | Qualitative | Many poor patients were unable to purchase medication. | |
| Kühlbrandt et al. | Armenia, Belarus, Moldova, and Ukraine (2014) | Qualitative | Out-of-pocket payment for medication was a major barrier for the poor to access medication. | |
| Rutebenberwa et al. | Uganda (2013) | Qualitative | Patients substituted the medication with herbs because medication was not affordable. | |
| Belue et al. | Mbour, Senegal (2012) | Qualitative | It is hard for poor patients to get their diabetes treated. | |
| Social capital | Bhojani et al. | India (2013) | Qualitative | Inadequate communication between providers and patients, patients’ negative attitude towards providers, and fragmented nature of health system had limited patient access to medication. |
| Higuchi | The Philippines (2010) | Qualitative | Limited local government commitment and budget has affected on low drug availability in public facilities. | |
| Kolling et al. | Tanzania (2010) | Qualitative | Patients drew supports from their social networks within their local communities to support their medication. | |
| Kühlbrandt et al. | Armenia, Belarus, Moldova, and Ukraine (2014) | Qualitative | Poorer regions cannot afford to provide free medication. Hence those who resided in those regions had more financial barriers in accessing medication. | |
| Rutebenberwa et al | Uganda (2013) | Qualitative | Trust to traditional healer increased the tendency of patients to use herbal medication. | |
| Belue et al. | Mbour, Senegal (2012) | Qualitative | Extended family and the financial systems were associated with diabetes management. | |
| Age | Ben Romdhane et al. | Tunisia (2014) | Quantitative | While it is non-linear, older people with diabetes has lower probability to be untreated compare to those aged 35–39 years old. |
| Le et al. | Yunan, China (2011) | Quantitative | Across the age groups, the lowest proportion of people being treated was found in 18–34 years old (5.2%), while the highest prevalence was among those aged 45–54 years old (32.4%). | |
| Higuchi | The Philippines (2010) | Qualitative | Older patients had less financial support for medication. | |
| Balabanova et al. | Georgia (2008) | Qualitative | Medication cost is particularly a burden for older people. | |
| Physical condition | Kolling et al. | Tanzania (2010) | Qualitative | Patients with poor physical condition experienced worse financial constrain to afford medication. |
| Health insurance | Sosa-Rubi et al. | Mexico (2009) | Quantitative | Those who were insured used more insulin per week than those who were not covered by health insurance (13 vs. 9, p>0.05). |
| Cunningham-Myrie et al. | Jamaica (2013) | Quantitative | 100% of people who had health insurance were treated compared to 92.4% of those who had no health insurance. | |
| Belue et al. | Mbour, Senegal (2012) | Qualitative | Health insurance could benefit access to medication. | |
DM, diabetes mellitus; LMICs, low- and middle-income countries.