Yin Xuejun, Wang Zhenzhong, Li Jia, Ke Jiawen, Jing Bin, Feng Wenshuai, Liu Qinglan, Yang Jingsong, Rasooly Alon, Beran David, Matsushita Kunihiro, Sarrafzadegan Nizal, Li Yuxiu, Feng Luzhao, Shao Ruitai
School of Public Health, Institute of Biomedical Innovation, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Nanchang University, Nanchang, China.
Lancet Reg Health West Pac. 2025 May 15;58:101574. doi: 10.1016/j.lanwpc.2025.101574. eCollection 2025 May.
Significant gaps remain in the screening, diagnosis, treatment, and control of hypertension and diabetes. This study aimed to assess the care cascade for these conditions in rural China, identifying barriers and facilitators at each stage to inform strategies for improving care delivery.
A sequential exploratory mixed methods study was conducted from July 2023 to June 2024 across three rural counties in China (Linqu, Gongyi, Wugang). The qualitative phase included in-depth interviews with policymakers, healthcare providers, and patients to identify contextual barriers and facilitators across each care cascade stage. Insights from the qualitative phase informed the design of a subsequent quantitative survey tool. The survey was administered to a stratified, non-random sample of rural residents to quantitatively assess factors identified in the qualitative phase.
Qualitative interviews were conducted with 82 participants, including 10 policymakers, 36 healthcare providers, and 36 patients with hypertension and/or diabetes. There were 7488 rural residents aged 35-74 years who completed the quantitative survey. Of these, 2668 (35.6%) had hypertension alone, 516 (6.9%) had diabetes alone, and 977 (13.0%) had both conditions. The care cascade for all conditions revealed significant gaps, with high rates of uncontrolled disease: 87.6% for hypertension, 72.3% for diabetes, and 96.6% for those with both conditions. Integrated qualitative and quantitative analyses highlighted key barriers at the patient level, including misconceptions about disease severity, low perceived need for care, and fear of diagnosis and lifelong medication use. Provider and system-level challenges, such as limited diagnostic capacity and inconsistent follow-up, were exacerbated by resource constraints in primary care. Facilitators included strong patient-provider relationships, targeted health education initiatives, the use of digital tools, and chronic disease reimbursement policies.
By combining qualitative and quantitative methods, the study identifies distinct care cascades for hypertension, diabetes, and comorbid hypertension and diabetes patients. The study highlights the need for integrated, context-specific strategies, including enhanced health education, stronger primary care systems, and the adoption of electronic health systems to improve the continuity of care in rural China.
This study was supported by the Chinese Academy of Medical Sciences through the following grants: Central Research Institute Fund (Grant Nos. 2022-ZHCH330-01 and 2021-RC330-004) and the Disciplines Construction Project: Population Medicine (Grant No. WH10022022010).
高血压和糖尿病的筛查、诊断、治疗及控制仍存在显著差距。本研究旨在评估中国农村地区这些疾病的医疗照护连续过程，确定每个阶段的障碍和促进因素，以为改善医疗服务提供策略提供依据。
2023年7月至2024年6月在中国三个农村县（临朐、巩义、武冈）开展了一项序贯探索性混合方法研究。定性阶段包括对政策制定者、医疗服务提供者和患者进行深入访谈，以确定每个医疗照护连续阶段的背景障碍和促进因素。定性阶段的见解为后续定量调查工具的设计提供了依据。该调查针对农村居民的分层非随机样本进行，以定量评估定性阶段确定的因素。
对82名参与者进行了定性访谈，包括10名政策制定者、36名医疗服务提供者以及36名高血压和/或糖尿病患者。有7488名年龄在35 - 74岁的农村居民完成了定量调查。其中，2668人（35.6%）仅患有高血压，516人（6.9%）仅患有糖尿病，977人（13.0%）同时患有这两种疾病。所有疾病的医疗照护连续过程均显示出显著差距，疾病控制率较高：高血压为87.6%，糖尿病为72.3%，两种疾病都有的患者为96.6%。定性和定量综合分析突出了患者层面的关键障碍，包括对疾病严重程度的误解、对医疗需求的低认知以及对诊断和终身用药的恐惧。初级保健资源限制加剧了医疗服务提供者和系统层面的挑战，如诊断能力有限和随访不一致。促进因素包括牢固的医患关系、有针对性的健康教育举措、数字工具的使用以及慢性病报销政策。
通过结合定性和定量方法，本研究确定了高血压、糖尿病以及高血压合并糖尿病患者的不同医疗照护连续过程。该研究强调需要采取综合的、因地制宜的策略，包括加强健康教育、强化初级保健系统以及采用电子健康系统，以改善中国农村地区的医疗连续性。
本研究由中国医学科学院通过以下资助支持：中央科研院所基金（项目编号：2022 - ZHCH330 - 01和2021 - RC330 - 004）以及学科建设项目：人口医学（项目编号：WH10022022010）。
