School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
The George Institute for Global Health, University of New South Wales, Sydney, Australia.
JMIR Public Health Surveill. 2024 Feb 16;10:e51802. doi: 10.2196/51802.
Hypertension and diabetes are global health challenges requiring effective management to mitigate their considerable burden. The successful management of hypertension and diabetes requires the completion of a sequence of stages, which are collectively termed the care cascade.
This scoping review aimed to describe the characteristics of studies on the hypertension and diabetes care cascade and identify potential interventions as well as factors that impact each stage of the care cascade.
The method of this scoping review has been guided by the framework by Arksey and O'Malley. We systematically searched MEDLINE, Embase, and Web of Science using terms pertinent to hypertension, diabetes, and specific stages of the care cascade. Articles published after 2011 were considered, and we included all studies that described the completion of at least one stage of the care cascade of hypertension and diabetes. Study selection was independently performed by 2 paired authors. Descriptive statistics were used to elucidate key patterns and trends. Inductive content analysis was performed to generate themes regarding the barriers and facilitators for improving the care cascade in hypertension and diabetes management.
A total of 128 studies were included, with 42.2% (54/128) conducted in high-income countries. Of them, 47 (36.7%) focused on hypertension care, 63 (49.2%) focused on diabetes care, and only 18 (14.1%) reported on the care of both diseases. The majority (96/128, 75.0%) were observational in design. Cascade stages documented in the literature were awareness, screening, diagnosis, linkage to care, treatment, adherence to medication, and control. Most studies focused on the stages of treatment and control, while a relative paucity of studies examined the stages before treatment initiation (76/128, 59.4% vs 52/128, 40.6%). There was a wide spectrum of interventions aimed at enhancing the hypertension and diabetes care cascade. The analysis unveiled a multitude of individual-level and system-level factors influencing the successful completion of cascade sequences in both high-income and low- and middle-income settings.
This review offers a comprehensive understanding of hypertension and diabetes management, emphasizing the pivotal factors that impact each stage of care. Future research should focus on upstream cascade stages and context-specific interventions to optimize patient retention and care outcomes.
高血压和糖尿病是全球性的健康挑战，需要有效的管理来减轻其巨大负担。高血压和糖尿病的成功管理需要完成一系列阶段，这些阶段统称为护理级联。
本范围综述旨在描述高血压和糖尿病护理级联研究的特征，并确定潜在的干预措施以及影响护理级联各个阶段的因素。
本范围综述的方法遵循 Arksey 和 O'Malley 的框架。我们使用与高血压、糖尿病和护理级联特定阶段相关的术语，系统地搜索了 MEDLINE、Embase 和 Web of Science。考虑了 2011 年后发表的文章，并纳入了描述至少完成高血压和糖尿病护理级联的一个阶段的所有研究。由 2 对独立作者进行研究选择。使用描述性统计来阐明关键模式和趋势。进行归纳内容分析，以生成有关改善高血压和糖尿病管理中护理级联的障碍和促进因素的主题。
共纳入 128 项研究，其中 42.2%（54/128）在高收入国家进行。其中，47 项（36.7%）侧重于高血压护理，63 项（49.2%）侧重于糖尿病护理，只有 18 项（14.1%）报告了两种疾病的护理。大多数（96/128，75.0%）为观察性设计。文献中记录的级联阶段包括意识、筛查、诊断、与护理的联系、治疗、药物依从性和控制。大多数研究侧重于治疗和控制阶段，而相对较少的研究检查了治疗开始前的阶段（76/128，59.4%比 52/128，40.6%）。有广泛的干预措施旨在增强高血压和糖尿病的护理级联。分析揭示了许多影响高收入和低收入及中等收入国家级联序列成功完成的个体和系统层面的因素。
本综述提供了对高血压和糖尿病管理的全面了解，强调了影响护理各个阶段的关键因素。未来的研究应侧重于上游级联阶段和特定于背景的干预措施，以优化患者保留和护理结果。
