Health service utilization and adherence to medication for hypertension and diabetes among Syrian refugees and affected
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RESEARCH ARTICLE
Health service utilization and adherence to medication for hypertension and diabetes among Syrian refugees and affected host communities in Lebanon Emily Lyles 1 & Gilbert Burnham 1 & Lara Chlela 2 & Paul Spiegel 1 & Laura Morlock 3 & The Lebanon Health Access Survey (LHAS) Study Team 1 & Shannon Doocy 1 Received: 12 July 2020 / Revised: 27 August 2020 / Accepted: 14 September 2020 # Springer Nature Switzerland AG 2020
Abstract Methods This study uses data from a 2015 household survey of Syrian refugees and Lebanese host communities. A total of 1,376 refugee and 686 host community households were surveyed using a cluster design with probability proportional to size sampling. Differences in outcomes of interest by population group were examined using Pearson’s chi-square and t-test methods and the crude and adjusted odds of care-seeking and interrupted medication adherence among Syrian refugees were estimated using logistic regression. Results Findings identified significant gaps between refugees and host community members in care-seeking, health facility utilization, out-of-pocket payments for care, and medication interruption. While host community members had better access to care and fewer reports of medication interruption compared to refugees, out-of-pocket spending for the most recent care visit was significantly higher among host community care-seekers. Refugee care-seekers most frequently received care at primary health facilities, choosing to do so mainly for reasons related to cost, whereas host community care-seekers predominantly utilized private clinics with greater concern for quality and continuity of care. Conclusion Further efforts are needed to facilitate lower and more predictable health service costs for refugees and vulnerable host community members, as is continued communication on available subsidized care. Purpose To characterize care-seeking, health service utilization and spending, and medication prescribing and adherence for hypertension and diabetes among Syrian refugees and host communities in Lebanon. Keywords Syria . Lebanon . Refugee health . Health care utilization . Adherence
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40200-020-00638-6) contains supplementary material, which is available to authorized users. * Emily Lyles [email protected] 1
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205 , USA
2
Médecins du Monde, Beirut, Lebanon
3
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
The influx of more than one million Syrian refugees since 2011 placed Lebanon as host to the highest number of refugees per capita worldwide [1, 2]. Contrary to the traditional model of providing refugee health care through a parallel system, refugee care is instead integrated into Lebanon’s existing health system [3–5]. The impact of this approach has been considerable strain on
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