title: Improving health related quality of life among rural hypertensive patients through the integrative strategy of health services delivery: a quasi-experimental trial from Chongqing, China.
abstract: Integrative strategy of health services delivery has been proven to be effective in economically developed countries, where the healthcare systems have enough qualified primary care providers. However rural China lacks such providers to act as gatekeeper, besides, Chinese rural hypertensive patients are usually of old age, more likely to be exposed to health risk factors and they experience a greater socio-economic burden. All these Chinese rural setting specific features make the effectiveness of integrative strategy of health services in improving health related quality of life among Chinese rural hypertensive patients uncertain.
  
  
  
  In order to assess the impact of integrative strategy of health services delivery on health related quality of life among Chinese rural hypertensive patients, a two-year quasi-experimental trial was conducted in Chongqing, China. At baseline the sample enrolled 1006 hypertensive patients into intervention group and 420 hypertensive patients into control group. Physicians from village clinics, town hospitals and county hospitals worked collaboratively to deliver multidisciplinary health services for the intervention group, while physicians in the control group provided services without cooperation. The quality of life was studied by SF-36 Scale. Blood pressures were reported by town hospitals. The Difference-in-Differences model was used to estimate the differences in SF-36 score and blood pressure of both groups to assess the impact.
  
  
  
  The study showed that at baseline there was no statistical difference in SF-36 scores between both groups. While at follow-up the intervention group scored higher in overall SF-36, Role Physical, Body Pain, Social Functioning and Role Emotional than the control group. The Difference-in-Differences result demonstrated that there were statistical differences in SF-36 total score (p = 0.011), Role Physical (p = 0.027), Social Functioning (p = 0.000), Role Emotional (p = 0.002) between both groups. Integrative services delivery improved the score of SF-36 by 4.591 ± 1.794, and also improved the score in domains of Role Physical, Social Functioning and Role Emotional by 8.289 ± 3.753, 9.762 ± 2.019 and 12.534 ± 4.083, respectively.
  
  
  
  Patients in the intervention group obtained lower systolic blood pressure and diastolic blood pressure. Integrative strategy of health services delivery improved health related quality of life and blood pressure control among rural Chinese hypertensive patients.
  
  
  
  The Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, ChiCTR-OOR-14005563, Registered on 7 June 2011.
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei Province, China.
authors.forename: Yudong
authors.initials: Y
authors.lastname: Miao
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei Province, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Learning, Informatics, Management and Ethics (LIME) Karolinska Institutet, Stockholm, Sweden.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Sparring
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei Province, China.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sandeep
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei Province, China.
authors.forename: Wenxi
authors.initials: W
authors.lastname: Tang
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei Province, China.
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Sun
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei Province, China.
authors.forename: Da
authors.initials: D
authors.lastname: Feng
authors.affiliation: School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei Province, China. 758566607@qq.com.
authors.forename: Ting
authors.initials: T
authors.lastname: Ye
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002681:China; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012424:Rural Population / Q000706:statistics & numerical data*
keywords: Difference-in-differences; Health-related quality of life; Hypertension; Quasi-experimental trial; SF-36