Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China.
Department of Operation Management, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
BMC Health Serv Res. 2022 Jul 1;22(1):849. doi: 10.1186/s12913-022-08179-9.
Improving primary care providers' competence is key to detecting and managing hypertension, but evidence to guide this work has been limited, particularly for rural areas. This study aimed to use standardized clinical vignettes to assess the competence of providers and the ability of the primary healthcare system to detect and manage hypertension in rural China.
A multi-stage random sampling method was administered to select target health facilities, providers, and households. The clinical vignette script was developed to evaluate provider competence in managing first-visit patients with symptoms of hypertension. Logistic regression was used to explore the factors correlated with provider competence. Provider referral and management rates were combined with patients' facility sorting behaviors to assess the ability of the rural healthcare system to manage hypertension in three policy scenarios.
A total of 306 providers and 153 facilities were enrolled in our study. In the 306 clinical vignette interactions, 25.9% of providers followed the national guidelines for hypertension consultation. The correct diagnosis was achieved by only 10.1% of providers, and 30.4% of providers were able to prescribe the correct treatment. Multi-variable regression results showed that younger providers (OR = 0.85, 95%CI: 0.73, 0.98) and those who work in township health centers (OR = 4.47, 95%: 1.07, 18.67) were more likely to provide a correct diagnosis. In a free-selection scenario, 29.8% of patients with hypertension were managed correctly throughout the rural system. When all patients first visit village clinics, system-level correct management is reduced to 20.5% but increases to 45.0% when all patients first visit township health centers.
Rural primary care providers do not have enough competence to detect and treat hypertension cases in China to an acceptable degree. Policy constraints may limit the competence of the rural healthcare system. Research to improve detection and treatment competence in hypertension and optimize health policy is needed.
提高初级保健提供者的能力是发现和管理高血压的关键，但指导这项工作的证据有限，特别是在农村地区。本研究旨在使用标准化临床病例来评估提供者的能力以及中国农村初级保健系统发现和管理高血压的能力。
采用多阶段随机抽样方法选择目标卫生机构、提供者和家庭。编写了临床病例脚本，以评估提供者管理有高血压症状的初诊患者的能力。采用逻辑回归探讨与提供者能力相关的因素。将提供者转诊和管理率与患者对医疗机构的选择行为相结合，在三种政策情景下评估农村医疗系统管理高血压的能力。
共纳入 306 名提供者和 153 家医疗机构。在 306 次临床病例互动中，25.9%的提供者遵循了国家高血压咨询指南。仅有 10.1%的提供者做出了正确诊断，30.4%的提供者能够开出正确的治疗方案。多变量回归结果显示，年轻的提供者（OR=0.85，95%CI：0.73，0.98）和在乡镇卫生院工作的提供者（OR=4.47，95%CI：1.07，18.67）更有可能做出正确诊断。在自由选择情景下，农村系统中正确管理的高血压患者比例为 29.8%。当所有高血压患者首次就诊于村诊所时，系统层面的正确管理比例降至 20.5%，但当所有患者首次就诊于乡镇卫生院时，该比例增至 45.0%。
中国农村初级保健提供者在发现和治疗高血压病例方面的能力不足，无法达到可接受的程度。政策限制可能会限制农村医疗保健系统的能力。需要研究如何提高高血压的发现和治疗能力并优化卫生政策。
