ArticleBMJ open2026
Patient-reported unmet healthcare needs among people with diabetic kidney disease in primary care in Peninsular Malaysia: a sequential mixed-methods study.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesDespite 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.
designA 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.
settingPatients were recruited from 45 primary care clinics in Peninsular Malaysia from March to May 2024.
participantsSurvey data were collected from 131 adults with an estimated glomerular filtration rate between 30 and 89 mL/min/1.73 m
main outcome measuresThe 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.
resultsThe 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.
conclusionThe 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.
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