Li Jian-xin, Liang Xiao-hua, Cao Jie, Zhu Kun, Deng Ying, Zhou Zheng-yuan, Wang Yi, Wan Guo-sheng, Zhao Chuan, Mu Quan-cheng, Lu Fang-hong, Gu Dong-feng
Department of Evidence Based Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2013 Apr;47(4):301-5.
To investigate the status of the clinical agency of detection, management, and health insurance for hypertensive patients in urban and rural communities of five provinces in China in 2010, in order to provide fundamental data for implementation and evaluation of community health management of hypertensive patients in basic public health service.
From Jiangsu, Shandong, Hebei, Sichuan and Gansu provinces, cities and districts (counties) were selected according to economic development level and 10 survey sites were finally determined. In each survey site, 3-4 communities or townships were selected by cluster sampling methods in 2010. A total of 8326 eligible hypertensive patients (4363 in urban and 3963 in rural) were included. The urban-rural difference of clinical agency and health insurance was compared for hypertensive patients.
In urban areas, 43.74% (1867/4268) hypertensive patients were first diagnosed at hospitals of district level or above, 25.07% (1070/4268) at community health service centers (CHSC), and 20.20% (862/4268) at community health service stations (CHSS), respectively; 30.72% (1274/4147) and 31.11% (1290/4147) patients chose CHSC and CHSS for their follow-up visiting, respectively; 60.23% (3073/5102) antihypertensive medication was obtained from pharmacies. In rural areas, 54.58% (2133/3908) hypertensive patients were first diagnosed at village clinics, 22.36% (874/3908) at township hospitals, and 18.86% (737/3908) at hospitals of county level or above; 70.49% (2695/3823) patients chose village clinics for their follow-up visiting; 46.23% (2116/4577) antihypertensive medication was obtained from village clinics, and 36.29% (1661/4577) from pharmacies. The main reasons for choosing clinical agency for both urban and rural patients were convenience (45.79%, 6276/13 706) and low cost (11.78%, 1614/13 706). The proportions of reimbursements for hospitalization expenses and total medical expenses for hypertensive patients in urban in the past year were 66.67% and 34.78%, respectively, which were much higher than those in rural (35.71% and 9.50%) (Z value was -12.13 and -17.56, P < 0.01).
Community-based hypertension detection and routine blood pressure measurement during clinical visiting should be further strengthened to improve early diagnosis of hypertension. The development of community-based clinical agency should be able to provide convenient and low cost health service for hypertensive patients to improve treatment, follow-up and control of hypertension.
了解2010年我国五省城乡社区高血压患者的检出、管理及医保情况，为基本公共卫生服务中高血压患者社区健康管理的实施与评价提供基础资料。
根据经济发展水平从江苏、山东、河北、四川和甘肃五省选取市、区（县），最终确定10个调查点。2010年在每个调查点采用整群抽样方法选取3 - 4个社区或乡镇。共纳入8326例符合条件的高血压患者（城市4363例，农村3963例）。比较高血压患者城乡临床机构及医保的差异。
城市地区，43.74%（1867/4268）的高血压患者首次诊断于区级及以上医院，25.07%（1070/4268）于社区卫生服务中心，20.20%（862/4268）于社区卫生服务站；30.72%（1274/4147）和31.11%（1290/4147）的患者分别选择社区卫生服务中心和社区卫生服务站进行随访；60.23%（3073/5102）的降压药从药店获取。农村地区，54.58%（2133/3908）的高血压患者首次诊断于村卫生室，22.36%（874/3908）于乡镇卫生院，18.86%（737/3908）于县级及以上医院；70.49%（2695/3823）的患者选择村卫生室进行随访；46.23%（2116/4577）的降压药从村卫生室获取，36.29%（1661/4577）从药店获取。城乡患者选择临床机构的主要原因均为方便（45.79%，6276/13706）和费用低（11.78%，1614/13706）。城市高血压患者过去一年住院费用和总医疗费用的报销比例分别为66.67%和34.78%，远高于农村（35.71%和9.50%）（Z值分别为 - 12.13和 - 17.56，P < 0.01）。
应进一步加强以社区为基础的高血压检出及临床就诊时的常规血压测量，以提高高血压的早期诊断。发展以社区为基础的临床机构，应为高血压患者提供方便、低成本的健康服务，以改善高血压的治疗、随访及控制。
