Abstract
This study aims to identify the characteristics and trajectories of outpatient service utilisation for hypertensive patients in tertiary hospitals. This study also attempts to investigate the determinants of the trajectories of outpatient service utilisation. A total of 9822 patients with hypertension and hypertension-related medical utilisation were recruited in Yichang, China from January 1 to December 31 in 2016. The latent trajectories of outpatient service utilisation were identified through latent class growth analysis. Differences in the demographic characteristics and medical utilisation among patients in different trajectories were tested by one-way ANOVA and chi-square analysis. The predictors of the trajectory groups of outpatient service utilisation were identified through multinomial logistic regression. Four trajectory groups were determined as stable-low (34.7%), low-fluctuating (13.4%), high-fluctuating (22.5%), and stable-high (29.4%). Significant differences were observed in all demographic characteristics (p < 0.001) and medical service utilisation variables (p < 0.001) among the four trajectories except for inpatient cost (p = 0.072). Determinants for outpatient service utilisation patterns include the place of residence, education level, outpatient visit times, inpatient service utilisation, and outpatient cost. Overall, hypertensive patients visiting outpatient units in the tertiary hospital were middle-aged, elderly, and well-educated, and they received poor follow-up services. The four identified latent trajectories have different characteristics and medical utilisation patterns. Trajectory group-based measurements are necessary for hypertension management and economic burden reduction.
Highlights
Hypertension is recognised as a serious, worldwide public health concern and a great public health challenge because of its high prevalence [1] (40% worldwide in 2010)
Hypertensive patients were recognised through the name list from the Hypertension Management
The average age of hypertensive patients involved in this study was 64.77 years
Summary
Hypertension is recognised as a serious, worldwide public health concern and a great public health challenge because of its high prevalence [1] (40% worldwide in 2010). The number of hypertensive patients is expected to grow to 1.56 billion in 2025 [2,3,4]. U.S increased slightly from 28.4% in 1999–2000 to 29.3% in 2013–2014 [5,6]. The overall prevalence of hypertension in Germany increased from 30% in 1998 to 32% in 2008–2011 [7]. The prevalence of hypertension is extremely high in developing countries, especially in China [8,9]. The prevalence of hypertension among adults in China increased from 18.8% in 2002 [10].
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