{
  "abstract": "People with multiple long-term conditions (MLTC) in low-resource settings face high treatment burdens, influenced by healthcare access and quality disparities. The study aimed to compare the treatment burden among patients with MLTC across geographical locations and healthcare providers in Peru. We conducted a cross-sectional study conducted between June–October 2023 among outpatients aged ≥40 years with type 2 diabetes and ≥1 additional chronic condition, recruited from public and private healthcare facilities in urban Lima and semi-urban Tumbes, Peru. Treatment burden was assessed using the Multimorbidity Treatment Burden Questionnaire (MTBQ). Differences in median MTBQ scores by setting and healthcare provider were analyzed using regression models adjusting for capacity- and workload-related variables. Among 555 participants (55% female, mean age 62.4 ± 10.5 years), median MTBQ score was 27.1 (IQR 14.6-41.7). After adjustment, patients in semi-urban Tumbes had higher treatment burden than those in urban Lima (adjusted median difference 6.1 points; 95% CI 2.9 to 9.3), while patients receiving care in private facilities had lower treatment burden than those in public settings (−6.6 points; 95% CI −9.3 to −3.9). These findings highlight substantial inequalities in treatment burden by place and provider type, with implications for efforts to improve care delivery and reduce disparities for people living with MLTC.",
  "abstract_shown": true,
  "affiliations": [
    "CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru",
    "Department of Medicine, Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru",
    "Center for research in Primary Health Care, Universidad Peruana Cayetano Heredia, Lima, Peru",
    "Research Department of Primary Care and Population Health, University College London, London, United Kingdom",
    "Department of General Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America",
    "Departments of Neurology, Global Health, Medicine (Infectious Diseases), and Epidemiology, University of Washington, Seattle, Washington, United States of America",
    "Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America",
    "Faculty of Medicine, Universidad de San Martín de Porres, Lima, Peru",
    "Department of Internal Medicina, Clínica Internacional, Lima, Peru",
    "School of Medicine, Universidad Peruana Union, Lima, Peru",
    "Department of Medicine, Clínica Good Hope, Lima, Peru",
    "Corporate Medical Directorate, Clínica Médica Cayetano Heredia, Lima, Perú",
    "Department of Postgraduate Studies, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru",
    "Department of Endocrinology, Hospital Arzobispo Loayza, Lima, Perú"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Silvana Perez-Leon"
    },
    {
      "affs": [
        1
      ],
      "name": "Daniel Mendoza-Quispe"
    },
    {
      "affs": [
        2
      ],
      "name": "Maria Sofia Cuba-Fuentes"
    },
    {
      "affs": [
        3
      ],
      "name": "Juan Carlos Bazo-Alvarez"
    },
    {
      "affs": [
        4
      ],
      "name": "M. Amalia Pesantes"
    },
    {
      "affs": [
        5
      ],
      "name": "Andrea Gaspar"
    },
    {
      "affs": [
        6
      ],
      "name": "Joseph R. Zunt"
    },
    {
      "affs": [
        7
      ],
      "name": "Victor M. Montori"
    },
    {
      "affs": [
        8
      ],
      "name": "Jose Armando Castillo"
    },
    {
      "affs": [
        9
      ],
      "name": "Eduardo Carcausto"
    },
    {
      "affs": [
        10
      ],
      "name": "Nelson Diaz"
    },
    {
      "affs": [
        11
      ],
      "name": "Keveen Salirrosas"
    },
    {
      "affs": [
        12
      ],
      "name": "Pilar Cornejo"
    },
    {
      "affs": [
        13
      ],
      "name": "J. Jaime Miranda"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/85t6mehvtsvez.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pgph.0007355",
  "fulltext_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007355",
  "id": "85t6mehvtsvez",
  "issns": [
    "2767-3375"
  ],
  "landing_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007355",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Chronic Disease Management Strategies"
    ],
    [
      "plos",
      "/Earth sciences/Geography/Economic geography/Low and middle income countries"
    ],
    [
      "plos",
      "/Earth sciences/Geography/Human geography/Urban geography"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Health care facilities"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Health care providers"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Patients/Inpatients"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Patients/Outpatients"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Socioeconomic aspects of health"
    ],
    [
      "plos",
      "/Medicine and health sciences/Public and occupational health/Socioeconomic aspects of health"
    ],
    [
      "plos",
      "/People and places/Geographical locations/South America/Peru"
    ],
    [
      "plos",
      "/Social sciences/Economics/Economic geography/Low and middle income countries"
    ],
    [
      "plos",
      "/Social sciences/Human geography/Urban geography"
    ]
  ],
  "openalex": "W7214742996",
  "pdf_url": "https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0007355&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-29",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/85t6mehvtsvez.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:37Z",
      "native_id": "10.1371/journal.pgph.0007355",
      "source": "plos",
      "url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007355"
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  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "plos:public and occupational health",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Disparities in treatment burden in Peru among people with multiple long-term conditions by geography and healthcare facility: A cross-sectional study",
  "title_text": "Disparities in treatment burden in Peru among people with multiple long-term conditions by geography and healthcare facility: A cross-sectional study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:37Z",
  "url": "https://research.draconitic.com/paper/85t6mehvtsvez",
  "venue": "PLOS Global Public Health",
  "versions": []
}