Charoendee Kulpimol, Sriratanaban Jiruth, Aekplakorn Wichai, Hanvoravongchai Piya
Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
BMC Health Serv Res. 2018 Mar 27;18(1):208. doi: 10.1186/s12913-018-2996-y.
Hypertension (HT) is a major risk factor, and accessible and effective HT screening services are necessary. The effective coverage framework is an assessment tool that can be used to assess health service performance by considering target population who need and receive quality service. The aim of this study is to measure effective coverage of hypertension screening services at the provincial level in Thailand.
Over 40 million individual health service records in 2013 were acquired. Data on blood pressure measurement, risk assessment, HT diagnosis and follow up were analyzed. The effectiveness of the services was assessed based on a set of quality criteria for pre-HT, suspected HT, and confirmed HT cases. Effective coverage of HT services for all non-HT Thai population aged 15 or over was estimated for each province and for all Thailand.
Population coverage of HT screening is 54.6%, varying significantly across provinces. Among those screened, 28.9% were considered pre-HT, and another 6.0% were suspected HT cases. The average provincial effective coverage was at 49.9%. Around four-fifths (82.6%) of the pre-HT group received HT and Cardiovascular diseases (CVD) risk assessment. Among the suspected HT cases, less than half (38.0%) got a follow-up blood pressure measurement within 60 days from the screening date. Around 9.2% of the suspected cases were diagnosed as having HT, and only one-third of them (36.5%) received treatment within 6 months. Within this group, 21.8% obtained CVD risk assessment, and half of them had their blood pressure under control (50.8%) with less than 1 % (0.7%) of them managed to get the CVD risk reduced.
Our findings suggest that hypertension screening coverage, post-screening service quality, and effective coverage of HT screening in Thailand were still low and they vary greatly across provinces. It is imperative that service coverage and its effectiveness are assessed, and both need improvement. Despite some limitations, measurement of effective coverage could be done with existing data, and it can serve as a useful tool for performance measurement of public health services.
高血压是主要风险因素，因此可及且有效的高血压筛查服务必不可少。有效覆盖框架是一种评估工具，可通过考虑需要并接受优质服务的目标人群来评估卫生服务绩效。本研究旨在衡量泰国省级高血压筛查服务的有效覆盖率。
获取了2013年超过4000万份个人卫生服务记录。对血压测量、风险评估、高血压诊断及随访数据进行了分析。基于一组针对高血压前期、疑似高血压和确诊高血压病例的质量标准评估服务的有效性。估算了泰国每个省份以及全泰国15岁及以上非高血压人群的高血压服务有效覆盖率。
高血压筛查的人群覆盖率为54.6%，各省之间差异显著。在接受筛查的人群中，28.9%被视为高血压前期，另有6.0%为疑似高血压病例。省级平均有效覆盖率为49.9%。约五分之四（82.6%）的高血压前期组接受了高血压及心血管疾病（CVD）风险评估。在疑似高血压病例中，不到一半（38.0%）在筛查日期后的60天内进行了随访血压测量。约9.2%的疑似病例被诊断为患有高血压，其中只有三分之一（36.5%）在6个月内接受了治疗。在该组中，21.8%进行了CVD风险评估，其中一半（50.8%）血压得到控制，只有不到1%（0.7%）的人成功降低了CVD风险。
我们的研究结果表明，泰国的高血压筛查覆盖率、筛查后服务质量以及高血压筛查的有效覆盖率仍然较低，且各省之间差异很大。必须对服务覆盖率及其有效性进行评估，二者都需要改进。尽管存在一些局限性，但利用现有数据可以进行有效覆盖率的测量，它可作为公共卫生服务绩效评估的有用工具。
