Yin Xuejun, Wang Zhenzhong, Yang Jingsong, Li Jia, Han Shasha, Feng Wenshuai, Liu Qinglan, Li Ning, Zhang Lihui, Ke Jiawen, Wei Xiaoxia, Zhang Juan, Sarrafzadegan Nizal, Shao Ruitai
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.
J Clin Hypertens (Greenwich). 2024 Dec;26(12):1466-1478. doi: 10.1111/jch.14918. Epub 2024 Nov 4.
The management of hypertension and diabetes poses significant challenges to China's healthcare system, necessitating seamless patient progression through screening, diagnosis, management, and control. Utilizing the care cascade model, this study aims to systematically identify patient drop-offs and devise strategies to address healthcare delivery bottlenecks for hypertension and diabetes in rural China. This study consists of three phases. In Phase 1, qualitative interviews are conducted to explore healthcare experiences and identify determinants across the care cascade. Phase 2 involves systematically assessing barriers identified in Phase 1 and collaborating with local stakeholders using intervention mapping and co-design to generate interventions and implementation strategies. Phase 3 is a cluster randomized controlled trial involving 48 villages, randomly assigned in a 1:1 ratio, to compare changes in hypertension and diabetes care. Intervention villages will implement interventions developed in Phase 2 for 1 year, while control villages will continue with usual care. Primary outcomes include between-group differences in achieving blood pressure and glycemic targets, along with service and implementation outcomes. This study aims to identify the stage with the largest patient retention gap in the care cascade and develop intervention strategies through participatory co-design with practitioners, emphasizing feasible, low-cost approaches. The pragmatic cluster RCT will assess strategy effectiveness, offering valuable insights for practical interventions to enhance hypertension and diabetes care in rural settings, potentially shaping impactful programs and improving healthcare outcomes. Trial Registration: ClinicalTrials.gov. identifier: NCT06141278.
高血压和糖尿病的管理给中国的医疗体系带来了重大挑战，这就需要患者在筛查、诊断、管理和控制等各个环节都能顺利推进。本研究采用医疗级联模型，旨在系统地识别患者流失情况，并制定策略以解决中国农村地区高血压和糖尿病医疗服务提供过程中的瓶颈问题。本研究包括三个阶段。在第一阶段，进行定性访谈以探索医疗体验，并识别整个医疗级联过程中的决定因素。第二阶段包括系统评估第一阶段识别出的障碍，并利用干预映射和共同设计与当地利益相关者合作，以制定干预措施和实施策略。第三阶段是一项整群随机对照试验，涉及48个村庄，按1:1的比例随机分配，以比较高血压和糖尿病治疗的变化。干预村庄将实施第二阶段制定的干预措施为期1年，而对照村庄将继续提供常规护理。主要结果包括实现血压和血糖目标方面的组间差异，以及服务和实施结果。本研究旨在识别医疗级联过程中患者留存差距最大的阶段，并通过与从业者的参与式共同设计制定干预策略，强调可行、低成本的方法。这项务实的整群随机对照试验将评估策略的有效性，为在农村地区加强高血压和糖尿病护理的实际干预措施提供有价值的见解，可能塑造有影响力的项目并改善医疗结果。试验注册：ClinicalTrials.gov。标识符：NCT06141278。
