School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, 430030, China.
BMC Prim Care. 2023 Sep 6;24(1):178. doi: 10.1186/s12875-023-02139-w.
The prevalence of hypertension is high (25.2% in 2012) and there were a large number of patients with hypertension (more than 200 million) in China. Township health centres in rural areas and community health centres in urban areas are responsible for hypertension management. This study aims to identify trends in hypertension management output and related facility-level, geographical and economic factors in primary care facilities and to assess the effect of the national project of basic public health services in China from 2009 to 2017.
A cross-sectional survey (2018) was combined with retrospective data collection (2009-2017) from 685 primary care facilities in six provinces in China. The hypertension management output was indicated by the number of patients with hypertension under management per 10,000 population. Latent class growth analysis and group-based trajectory models were applied to classify trajectories and determine associations with facility-level, geographic and economic characteristics.
The trend in the output increased rapidly from 2009 to 2012 with an average growth rate of 54.58% and slowed down from 2012 to 2017 (growth rate of 5.94%). Five trajectories of the output were identified and labelled according to baseline status and increase rates: low-gradually increasing (16.9%), middle-slightly increasing (16.2%), low-sharply increasing (7.9%), middle-sharply increasing (34.2%) and persistently high (24.9%). The time-stable characteristics, including region (eastern, central or western), district (urban or rural), landform, were associated with hypertension management output of the facilities. Number of public health physicians was a significant time-dependent characteristic influencing management output.
Five latent trajectories of hypertension management output were identified. The output was still at a low level compared with the prevalence of hypertension. Hypertension screening in young people need to be emphasized. Facilities are recommended to establish good relationships with residents for better hypertension management outcomes especially in urban areas.
高血压的患病率较高（2012 年为 25.2%），中国有大量高血压患者（超过 2 亿）。农村乡镇卫生院和城市社区卫生服务中心负责高血压管理。本研究旨在确定基层医疗保健设施中高血压管理输出的趋势以及相关的设施水平、地理和经济因素，并评估中国 2009 年至 2017 年基本公共卫生服务国家项目的效果。
本研究采用横断面调查（2018 年）与来自中国六个省份的 685 个基层医疗保健设施的回顾性数据收集（2009-2017 年）相结合。高血压管理输出以每 10,000 人口管理的高血压患者人数表示。应用潜在类别增长分析和基于群组的轨迹模型对轨迹进行分类，并确定与设施水平、地理和经济特征的关联。
从 2009 年到 2012 年，输出呈快速增长趋势，增长率为 54.58%，2012 年至 2017 年增长率放缓至 5.94%。根据基线状态和增长率确定了输出的五个轨迹，并进行了标记：低-逐渐增加（16.9%）、中-略增加（16.2%）、低-急剧增加（7.9%）、中-急剧增加（34.2%）和持续高（24.9%）。时间稳定特征，包括地区（东部、中部或西部）、区（城市或农村）、地形，与设施的高血压管理输出有关。公共卫生医师人数是影响管理输出的重要时间依赖性特征。
确定了高血压管理输出的五个潜在轨迹。与高血压患病率相比，输出仍处于较低水平。需要强调对年轻人进行高血压筛查。建议设施与居民建立良好的关系，以获得更好的高血压管理结果，特别是在城市地区。
