Analysis On The Current Situation And Effectiveness Of Hypertension Control In Rural China

ObjectivesThe study was conducted to analyze the effectiveness of hypertension control and relative influencing factors by investigating the current situation of essential public health service in rural areas of8cities. The study aims to provide recommendations for further improvement of hypertension control.MethodsQuestionnaire and in-depth interview were used in this research. The study subjects included24primary health care institutions which had implemented the hypertensive patient management of essential public health service,189health care workers who were in charge of chronic diseases control,2362patients aged35and above who had participated in the hypertensive patient management for more than one year.Results128.1%of hypertensive patients received management in study areas, among which58.6%met the standard of management process. The blood pressure control rate was36.6%.2Clinicians, General medical practitioners, public health doctors and nurses accounted for33.9%,26.3%,13.4%and14.5%respectively of health care workers who were in charge of hypertensive patient management, among whom72.4%were part-time staff.61.3%of health care workers thought the number of actually managed patients exceeded the maximum acceptable number.3The proportion of guidance on diet, physical exercise, smoking cessation, alcohol control and psychological dredge provided by community doctor were93.2%,78.8%,74.1%,73.8%.The main medical services provided in follow-up visits were asking symptoms, measuring heart rate and blood pressure. The proportion of prescribing drugs and referring patients were relatively low-1.5%and0.4%respectively.77.6%of hypertensive patients were satisfied with community doctors during follow-up visits.4The awareness rate of hypertensive patients to hypertension criteria and to the standard of daily salt intake was35.5%and14.1%respectively. There was still a certain proportion of patients who smoked, drunk, didn’t do exercise, took excessive oil and salt or took insufficient vegetables and fruits. The proportion of patients who had these unhealthy lifestyles was higher among rural patients. There were73.8%of hypertensive patients who took anti-hypertensive drugs and medication adherence rate was48.8%. The most reported reason for non-adherence was inconvenience of taking the medicine (82%). The overweight rate and obesity rate among hypertensive patients were34%and14.5%respectively. The proportion of central obesity was58.9%.7.3%of hypertensive patients had coronary heart disease simultaneously,4.6%had stroke and5.9%had diabetes.24.4%of hypertensive patients considered themselves in good health.5Hypertension patients in eastern, middle and western area has significance in the respect of marriage status, age, annual income, knowledge about hypertension, life behavior(smoking rate, drinking rate and exercise rate),overweight and obesity rate, follow-up, blood pressure surveillance behavior and adherence to drugs.(P<0.05). regulated management rate and blood control rate among eastern and mid area than western area.6Multi-variable analysis result shows that after adjusting other factors, control rate of blood pressure among patients in eastern area is comparatively higher than western area; comparing to the un-regulated managed patient, regulated managed patient has a higher control rate of blood pressure; fruits intake and adherence to drugs and blood control rate has positive correlation. Family annual income, weight index of hypertension, pickles intake and control rate of blood pressure is negative correlation.Conclusion1The management rate, standard management rate and blood pressure control rate were relatively low in study areas, thus extending coverage rate of hypertensive patient management was recommended; standard management rate need to be increased by meeting the required number of follow-up visit; blood pressure control rate was the key indicator which need to be increased, as this was the ultimate objective of hypertensive patient management.2Comparing with non-standard management group, patients who received standard management had a higher satisfaction rate; had a higher awareness rate of hypertension control knowledge; measured blood pressure more frequently; had a higher treatment rate and medication adherence rate; had a lower smoking rate; were less likely to eat salty food and take excessive oil; had a higher control rate of blood pressure.3Control rate of blood pressure among patients in eastern area is comparatively higher than western area; comparing to the un-regulated managed patient, regulated managed patient has a higher control rate of blood pressure; fruits intake and adherence to drugs and blood control rate has positive correlation. Family annual income, weight index of hypertension, pickles intake and control rate of blood pressure is negative correlation.