Miao Yudong, Zhang Liang, Sparring Vibeke, Sandeep Sandeep, Tang Wenxi, Sun Xiaowei, Feng Da, Ye Ting
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei Province, China.
Department of Learning, Informatics, Management and Ethics (LIME) Karolinska Institutet, Stockholm, Sweden.
Int J Equity Health. 2016 Aug 23;15(1):132. doi: 10.1186/s12939-016-0421-x.
Integrative strategy of health services delivery has been proven to be effective in economically developed countries, where the healthcare systems have enough qualified primary care providers. However rural China lacks such providers to act as gatekeeper, besides, Chinese rural hypertensive patients are usually of old age, more likely to be exposed to health risk factors and they experience a greater socio-economic burden. All these Chinese rural setting specific features make the effectiveness of integrative strategy of health services in improving health related quality of life among Chinese rural hypertensive patients uncertain.
In order to assess the impact of integrative strategy of health services delivery on health related quality of life among Chinese rural hypertensive patients, a two-year quasi-experimental trial was conducted in Chongqing, China. At baseline the sample enrolled 1006 hypertensive patients into intervention group and 420 hypertensive patients into control group. Physicians from village clinics, town hospitals and county hospitals worked collaboratively to deliver multidisciplinary health services for the intervention group, while physicians in the control group provided services without cooperation. The quality of life was studied by SF-36 Scale. Blood pressures were reported by town hospitals. The Difference-in-Differences model was used to estimate the differences in SF-36 score and blood pressure of both groups to assess the impact.
The study showed that at baseline there was no statistical difference in SF-36 scores between both groups. While at follow-up the intervention group scored higher in overall SF-36, Role Physical, Body Pain, Social Functioning and Role Emotional than the control group. The Difference-in-Differences result demonstrated that there were statistical differences in SF-36 total score (p = 0.011), Role Physical (p = 0.027), Social Functioning (p = 0.000), Role Emotional (p = 0.002) between both groups. Integrative services delivery improved the score of SF-36 by 4.591 ± 1.794, and also improved the score in domains of Role Physical, Social Functioning and Role Emotional by 8.289 ± 3.753, 9.762 ± 2.019 and 12.534 ± 4.083, respectively.
Patients in the intervention group obtained lower systolic blood pressure and diastolic blood pressure. Integrative strategy of health services delivery improved health related quality of life and blood pressure control among rural Chinese hypertensive patients.
The Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, ChiCTR-OOR-14005563, Registered on 7 June 2011.
在医疗体系拥有足够合格基层医疗服务提供者的经济发达国家，整合式医疗服务提供策略已被证明是有效的。然而，中国农村地区缺乏这类能充当“看门人”角色的提供者。此外，中国农村高血压患者通常年龄较大，更易暴露于健康风险因素之下，且承受着更大的社会经济负担。中国农村地区的所有这些特定特征使得整合式医疗服务策略在改善中国农村高血压患者健康相关生活质量方面的有效性存在不确定性。
为评估整合式医疗服务提供策略对中国农村高血压患者健康相关生活质量的影响，在中国重庆进行了一项为期两年的准实验性试验。基线时，样本中有1006名高血压患者被纳入干预组，420名高血压患者被纳入对照组。来自村卫生室、镇医院和县医院的医生协同工作，为干预组提供多学科医疗服务，而对照组的医生则独立提供服务。采用SF-36量表研究生活质量。血压由镇医院上报。使用双重差分模型估计两组SF-36评分和血压的差异，以评估影响。
研究表明，基线时两组的SF-36评分无统计学差异。而在随访时，干预组在SF-36总分、生理功能、身体疼痛、社会功能和情感职能方面的得分高于对照组。双重差分结果显示，两组在SF-36总分（p = 0.011）、生理功能（p = 0.027）、社会功能（p = 0.000）、情感职能（p = 0.002）方面存在统计学差异。整合式服务提供使SF-36评分提高了4.591±1.794，在生理功能、社会功能和情感职能领域的得分分别提高了8.289±3.753、9.762±2.019和12.534±4.083。
干预组患者的收缩压和舒张压更低。整合式医疗服务提供策略改善了中国农村高血压患者的健康相关生活质量和血压控制情况。
华中科技大学同济医学院伦理委员会，ChiCTR-OOR-14005563，于2011年6月7日注册。
