London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS Med. 2013;10(7):e1001490. doi: 10.1371/journal.pmed.1001490. Epub 2013 Jul 30.
Hypertension (HT) affects an estimated one billion people worldwide, nearly three-quarters of whom live in low- or middle-income countries (LMICs). In both developed and developing countries, only a minority of individuals with HT are adequately treated. The reasons are many but, as with other chronic diseases, they include weaknesses in health systems. We conducted a systematic review of the influence of national or regional health systems on HT awareness, treatment, and control.
Eligible studies were those that analyzed the impact of health systems arrangements at the regional or national level on HT awareness, treatment, control, or antihypertensive medication adherence. The following databases were searched on 13th May 2013: Medline, Embase, Global Health, LILACS, Africa-Wide Information, IMSEAR, IMEMR, and WPRIM. There were no date or language restrictions. Two authors independently assessed papers for inclusion, extracted data, and assessed risk of bias. A narrative synthesis of the findings was conducted. Meta-analysis was not conducted due to substantial methodological heterogeneity in included studies. 53 studies were included, 11 of which were carried out in LMICs. Most studies evaluated health system financing and only four evaluated the effect of either human, physical, social, or intellectual resources on HT outcomes. Reduced medication co-payments were associated with improved HT control and treatment adherence, mainly evaluated in US settings. On balance, health insurance coverage was associated with improved outcomes of HT care in US settings. Having a routine place of care or physician was associated with improved HT care.
This review supports the minimization of medication co-payments in health insurance plans, and although studies were largely conducted in the US, the principle is likely to apply more generally. Studies that identify and analyze complexities and links between health systems arrangements and their effects on HT management are required, particularly in LMICs. Please see later in the article for the Editors' Summary.
高血压（HT）影响了全球约 10 亿人，其中近四分之三生活在低收入和中等收入国家（LMICs）。在发达国家和发展中国家，仅有少数 HT 患者得到了充分治疗。原因有很多，但与其他慢性病一样，其中包括卫生系统的薄弱环节。我们对国家或地区卫生系统对 HT 知晓率、治疗和控制的影响进行了系统评价。
合格的研究分析了区域或国家卫生系统安排对 HT 知晓率、治疗、控制或降压药物依从性的影响。2013 年 5 月 13 日，检索了以下数据库：Medline、Embase、全球卫生、LILACS、非洲信息、IMSEAR、IMEMR 和 WPRIM。没有日期或语言限制。两名作者独立评估纳入研究，提取数据，并评估偏倚风险。对研究结果进行了叙述性综合分析。由于纳入研究的方法学存在很大差异，未进行荟萃分析。共纳入 53 项研究，其中 11 项在 LMICs 进行。大多数研究评估了卫生系统筹资，只有 4 项研究评估了人力、物力、社会或智力资源对 HT 结果的影响。降低药物共付额与 HT 控制和治疗依从性的改善有关，主要在美国进行评估。总的来说，医疗保险覆盖与美国 HT 护理结局的改善有关。有常规的医疗场所或医生与改善 HT 护理有关。
本综述支持在医疗保险计划中尽量减少药物共付额，尽管研究主要在美国进行，但这一原则可能更普遍适用。需要进行研究以确定和分析卫生系统安排的复杂性及其对 HT 管理的影响之间的联系，特别是在 LMICs。请在文章稍后部分查看编辑摘要。
