Health-related quality of life in elderly diabetic outpatients in Vietnam

Huong Thi Thu Nguyen,1,2 Mackenzie PI Moir,3 Thanh Xuan Nguyen,2,4 Anh Phuong Vu,5 Long Hoang Luong,2,4 Tam Ngoc Nguyen,1,2 Long Hoang Nguyen,6 Bach Xuan Tran,7,8 Tung Thanh Tran,9 Carl A Latkin,8 Melvyn WB Zhang,10 Roger CM Ho,11 Huyen Thanh Thi Vu1,2 1Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam; 2National Geriatric Hospital, Hanoi, Vietnam; 3School of Public Health, University of Alberta, Edmonton, AB, Canada; 4Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam; 5Hanoi Medical University, Hanoi, Vietnam; 6School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam; 7Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; 8Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 9Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam; 10Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, Singapore; 11Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Background: Health-related quality of life (HRQoL) is an important indicator for designing care and treatment services for patients with diabetes. This is especially true given its rapid increase among the elderly population in Vietnam. HRQoL data in elderly diabetic Vietnamese are currently limited. This study aimed to 1) measure the HRQoL of elderly patients with type 2 diabetes (T2DM) in Vietnam and 2) identify related factors and their relationship with HRQoL. Patients and methods: A cross-sectional study was conducted. We recruited 171 patients aged ≥60 years with T2DM at the Outpatient Department, National Geriatric Hospital from June to November 2015. Patients were asked to evaluate their health status using the EuroQol Five Dimensions Three Levels (EQ-5D-3L) and the Visual Analog Scale (VAS). Sociodemographic, diabetic treatment, and management characteristics were collected. Multivariate Tobit regression was used to determine which factors were associated with HRQoL, and the strength of this relationship. Results: Patients reported some problems in all areas of the EQ-5D: pain/discomfort (50.9%), mobility (33.3%), anxiety/depression (24.0%), usual activities (21.1%), and self-care (10.5%). The mean EQ-5D index score was 0.80 (SD=0.20), and the mean EQ-VAS was 57.5 (SD=14.4). Patients who were male, lived in an urban area, could afford treatment, were taking fewer medications, and monitored blood pressure often (1–4 times a week) had a higher EQ-5D index when compared to other groups. Meanwhile, a longer duration of diabetes and older age were negatively associated with the EQ-5D index. Patients with any comorbidity had lower VAS scores than their counterparts. Conclusion: The presence of diabetes and comorbidity were responsible for a significant decrease in HRQoL. Screening and identifying health problems, providing prompt treatment, and facilitating self-management among patients have the potential to increase diabetic patients’ HRQoL. Keywords: elder, quality of life, diabetes, Vietna

Improving antibiotic prescribing for community-acquired pneumonia in a provincial hospital in Northern Vietnam

Objectives To test the effectiveness of a quality improvement programme to promote adherence to national quality standards (QS) for patients hospitalized with community-acquired pneumonia (CAP), exploring the factors that hindered improvements in clinical practice. Methods An improvement bundle aligned to the QS was deployed using plan-do-study-act methodology in a 600 bed hospital in northern Vietnam from July 2018 to April 2019. Proposed care improvements included CURB65 score guided hospitalization, timely diagnosis and inpatient antibiotic treatment review to limit the spectrum and duration of IV antibiotic use. Interviews with medical staff were conducted to better understand the barriers for QS implementation. Results The study found that improvements were made in CURB65 score documentation and radiology results available within 4 h (P < 0.05). There were no significant changes in the other elements of the QS studied. We documented institutional barriers relating to the health reimbursement mechanism and staff cultural barriers relating to acceptance and belief as significant impediments to implementation of the standards. Conclusions Interventions led to some process changes, but these were not utilized by clinicians to improve patient management. Institutional and behavioural barriers documented may inhibit wider national uptake of the QS. National system changes with longer term support and investment to address local behavioural barriers are likely to be crucial for future improvements in the management of CAP, and potentially other hospitalized conditions, in Vietnam