title: Effects and cost-effectiveness of a guideline-oriented primary healthcare hypertension management program in Beijing, China: results from a 1-year controlled trial.
abstract: Hypertension control rates are unacceptably low in China. The present study demonstrates if a customized, guideline-oriented training program can cost-effectively improve hypertension management in primary healthcare. Four typical community health centers in Beijing were selected and randomized to intervention or control (one urban and one rural each). A sample of 140 patients with hypertension and blood pressure uncontrolled was recruited from each center. Primary healthcare providers in intervention centers provided management to the recruited patients for 1 year after receiving training with customized hypertension management guidelines, and primary healthcare providers in control provided with usual care. Intention-to-treat analysis showed that hypertension control (systolic blood pressure (SBP) <140 mm Hg and diastolic blood pressure (DBP) <90 mm Hg)) rate was significantly higher in interventions than controls at month 3 (42.1% vs. 34.3% in urban and 30.7% vs. 10.0% in rural centers) and the trend increased to month 12 (70.7% vs. 40.0% in urban and 72.9% vs. 27.9% in rural); P-values by logistic mixed model were all <0.001 for both urban and rural after adjustment for baseline multiple variables including blood pressure. Mean reductions of SBP and DBP were significantly larger in interventions. The intervention was cost-saving, with an average incremental cost-saving of US$ 20.3 per patient in urban sites and $ 7.0 per patient in rural sites. Corresponding results from per-protocol analysis were very similar. The customized, guideline-oriented hypertension management program in primary healthcare in China effectively improved blood pressure control and was cost-saving.
authors.affiliation: Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.forename: Weiqin
authors.initials: W
authors.lastname: Li
authors.forename: Xian
authors.initials: X
authors.lastname: Li
authors.forename: Ning
authors.initials: N
authors.lastname: An
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
authors.forename: Guanghua
authors.initials: G
authors.lastname: Ming
authors.forename: Qi
authors.initials: Q
authors.lastname: Hua
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Yan
authors.forename: Ningling
authors.initials: N
authors.lastname: Sun
authors.forename: Dong
authors.initials: D
authors.lastname: Zhao
authors.forename: Yangfeng
authors.initials: Y
authors.lastname: Wu
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000191:economics; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002681:China; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D057194:Intention to Treat Analysis; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics*; D012424:Rural Population; D018401:Sample Size; D012907:Smoking / Q000191:economics; D012923:Social Class; D014505:Urban Population
chemical_list: D000959:Antihypertensive Agents