ABSTRACT
@# Electronic medical records from hospital information system (HIS) offer a major potential for secondary data analysis which can improve the efficiency of healthcare delivery. This study describes an initiative to use HIS data to explore the level of diabetic care in patients with T2DM in a hospital-based outpatient clinic, the advantages and challenges in utilising HIS data. Methods: Patients age of 18 and above who received any diabetes medication in 2013 were retrospectively identified from HIS of Serdang Hospital. Demographic characteristics, anti-diabetic agent (ADA) dispensed, and glycaemic measures were quantified. Data was extracted using structured query language (SQL) and descriptive statistical analyses were conducted using Stata Version 12. Results: Prevalence of T2DM patients in the hospital was 7.5%. Male had slightly higher prevalence and patient at age of 61-70 years old. About 62% of patients were prescribed with metformin and 5% of newer combination of oral hypoglycemic agent. In prescribing pattern, stratification by age group, showed that patient age 41 to 70 years received mostly monotherapy, whilst 61.1% continue their regime for the year. Only 18% obtained good glycaemic control. Conclusion: Hospital Information system is a critical instrument in providing data as a platform in diabetic care in an outpatient care. Moving forward, steps to improve HIS should be taken to seize its potential as a tool to increase the efficiency of healthcare delivery.
ABSTRACT
@#Background: Equity is one of the important aspects of universal health coverage. Variation in socioeconomic status (SES) has been proved to contribute discrepancies in the use of healthcare services. This study aimed to assess equity for inpatient, outpatient and dental care utilisation by household SES over time. Methods: This study used five series of National Health and Morbidity Survey data from 1986 to 2015. Healthcare utilisation for inpatient, outpatient and dental care were analysed. SES was grouped based on household expenditure variables accounting for total number of adults and children in the household using consumption per adult equivalents approach. The determination of healthcare utilisation across the SES segments was measured using concentration index. Results: The overall distribution of inpatient utilisation tended towards the pro-poor, although only data from 1996 (P-value = 0.017) and 2006 (P-value = 0.021) were statistically significant (P < 0.05). Out-patient care showed changing trends from initially being pro-rich in 1986 (P < 0.05), then gradually switching to pro-poor in 2015 (P < 0.05). Dental care utilisation was significantly pro-rich throughout the survey period (P < 0.05). Public providers mostly showed significantly pro-poor trends for both in- and out-patient care (P < 0.05). Private providers, meanwhile, constantly showed a significantly pro-rich (P < 0.05) trend of utilisation. Conclusion: Total health utilisation was close to being equal across SES throughout the years. However, this overall effect exhibited inequities as the effect of pro-rich utilisation in the private sector negated the pro-poor utilisation in the public sector. Strategies to improve equity should be consistent by increasing accessibility to the private sectors, which has been primarily dominated by the richest population.