THE NEW TOOL AND RELATIONSHIP BETWEEN SERVICE QUALITY AND INPATIENT SATISFACTION IN MEASURING HEALTHCARE QUALITY

Background: Diabetes mellitus is one of public health concerns in Malaysia. Insulin therapy refusal is getting prevalent among Malaysian diabetic patients due to various attributes. The purpose of this study was to determine the prevalence of insulin therapy refusal among type 2 diabetes patients and to determine its associated factors. Materials and Methods: A cross-sectional study was conducted from August 2015 to February 2016 in four selected health clinics in East Coast Region of Peninsular Malaysia. Diabetic patients who fulfilled the study criteria were recruited. Descriptive statistics, simple and multiple logistic regressions were used for data analysis. Result: A total of 460 patients were recruited in this study. The prevalence of patients refused insulin therapy was 15.0%. The mean (±SD) age of patients refusing insulin therapy was 59.93 (±1.13) year old. Majority of insulin-refusing patients were female (76.8%), Malay (81.1%) and attained secondary education level (50.7%). The mean (±SD) duration of diabetes among insulin-refusing patients was 7.5 (±0.49) year. Majority of insulin-refusing patients had co-morbidities (84.1%) and diabetic complication (76.8%). Male gender, Malay ethnicity, duration of having diabetes and presence of diabetic complications were the significant associated factors for refusing insulin therapy with an adjusted odds ratio (AOR) of 2.41 (95%CI: 1.37,4.26; p=0.002), 4.17 (95%CI: 2.27,7.66; p<0.001), 0.92 (95%CI: 0.87,0.97; p=0.003) and  3.50 (95%CI: 1.37,8.98; p=0.009), respectively. Conclusion: Insulin therapy refusal is quite common in Malaysia. More proactive actions from healthcare providers needed in accordance to the pinpointed factors in order to attain better insulin therapy acceptance among diabetic patients. Keywords: insulin therapy refusal, prevalence, type 2 diabetes mellitus, associated factors.