Objectives Despite adherence to guideline-based pharmacotherapy, many people with diabetic kidney disease (DKD) were unable to meet glycaemic and blood pressure targets. The purpose of this paper was to report the unmet needs of people with early-stage DKD. Design A sequential mixed-methods approach was used, comprising a quantitative survey followed by an exploratory qualitative phase using nominal group technique (NGT) discussions with people with DKD. Setting Patients were recruited from 45 primary care clinics in Peninsular Malaysia from March to May 2024. Participants Survey data were collected from 131 adults with an estimated glomerular filtration rate between 30 and 89 mL/min/1.73 m 2 and with suboptimal glycaemia and blood pressure outcomes. Exploratory NGT discussions were conducted with seven participants. Main outcome measures The online survey used the WHO definition of unmet healthcare need as the ‘failure to seek healthcare when needed during the past twelve months’ to assess the prevalence and associated factors. Qualitative data and ranking of other perceived unmet needs of these people with DKD and suboptimal clinical outcomes were collected through NGT discussions. Results The prevalence of reported unmet healthcare needs per the WHO definition was 13%, with history of diabetic foot ulcer (adjusted OR (AOR) 6.67, 95% CI 1.22 to 37.25) and urban residence (AOR 3.70, 95% CI 1.26 to 12.89) reported as associated factors. NGT identified three patient-prioritised unmet needs: ‘dietary support’, ‘better medication’ and ‘mental health support’. Female participants prioritised obtaining medication and kidney health information, whereas male participants emphasised self-monitoring support. Conclusion The low prevalence of WHO-defined unmet need, alongside patient-prioritised concerns extending beyond standard measures, suggests that current operational definitions may not fully capture patient-perceived unmet healthcare needs in DKD.
Yap et al. (Mon,) studied this question.