Abstract
ObjectivesNon-communicable diseases (NCDs) have become the main cause of mortality in China. In 2009, the Chinese government introduced the Basic Public Health Service (BPHS) program to relieve the rising burden of NCDs through public health measures and delivery of essential medical care. The primary aim of this study was to evaluate the impact of the BPHS program on hypertension control.MethodsThe China National Health Development Research Center (CNHDRC) undertook a Cross-sectional Health Service Interview Survey (CHSIS) of 62,097 people from primary healthcare reform pilot areas across 17 provinces from eastern, central, and western parts of China in 2014. The current study is based on responses to the CHSIS survey from 7,867 participants, who had been diagnosed with hypertension. Multi-variable mixed logit regression analysis was used to estimate the association between BPHS management and uncontrolled hypertension. In a follow-up analysis, generalized structural equation modelling (GSEM) was used to test for mediation of the BPHS program effect through patient compliance with medication.FindingsThe estimated proportion of patients with uncontrolled hypertension was 30% lower (23.2% vs 31.5%) in those participants who were adequately managed under the BPHS program. Other predictors of hypertension control included compliance with medication, self-reported wellbeing, income, educational attainment and exercise; smoking was associated with reduced hypertension control. The significant inverse association between uncontrolled hypertension and age indicates poor outcomes for younger patients. Additional testing suggested that nearly 40% of the effect of BPHS management (95% CI: 28.2 to 51.7) could be mediated by improved compliance with medication; there was also an indication that the effect of management was 30% stronger in districts/counties with established digital information management systems (IMS).ConclusionHypertension control improved markedly following active management through the BPHS program. Some of that improvement could be explained by greater compliance with medication among program participants. This study also identified the need to tailor the BPHS program to the needs of younger patients to achieve higher levels of control in this population. Future investigations should explore ways in which existing healthcare management influences the success of the BPHS program.
Highlights
The leading causes of mortality in China have shifted relatively quickly from infectious diseases and perinatal conditions to chronic diseases and injuries [1,2]
This study aims to identify differences in hypertension control between patients managed by the Basic Public Health Services” (BPHS) program and those not managed by the program by using data from the Cross-sectional Health Service Interview Survey (CHSIS) conducted by the China National Health Development Research Center (CNHDRC)
This study examined the relationship between hypertension control and a disease management program, which was provided through the BPHS using data from the CHSIS
Summary
The leading causes of mortality in China have shifted relatively quickly from infectious diseases and perinatal conditions to chronic diseases and injuries [1,2] This has been accompanied by an increase in hypertension and other cardiovascular disease risk factors, which were responsible for 2,109,772 deaths from stroke and 1,750,038 deaths from ischemic heart disease in 2017 [3], making these factors the leading causes of death in China. One important measure was the program entitled “Basic Public Health Services” (BPHS) which supports community health organizations to deliver a defined package of basic health services throughout the country [5]. In urban areas, these organizations are called community health centres and stations; in rural areas they are township health centres and village clinics. A major aim of the program is to combat the increasing burden imposed by non-communicable diseases (NCDs), through a range of measures of management of hypertension and diabetes, including health education, improving medication compliances, control risk factors, such as smoking control, alcohol intake and combating obesity [6], in line with the recommendations by the World Health Organization for essential packages of interventions for non-communicable diseases by primary care facilities [7]
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