Grass-roots Level Of "high Blood Pressure Prevention And Control Of Practice" In The Beijing Urban And Rural Community Health Service Centers Effect Evaluation,

ObjectivesTo evaluate the effect on control of hypertension in typical urban and rural community health service centers of Beijing,by utilizing the Practice Guidelines on Prevention and Control of Hypertension in Community(the Guideline),the results of which will provide a basis upon which to popularize the Guideline.MethodsTypical sampling method was used to select four comparable community health service centers in Beijing,two from urban areas and another two from rural,the pairs comparable in economy level and geography.140 patients with high blood pressure who visited each of the four centers and met the inclusion criteria were invited to participate in the trial,and in the 12-month intervention period it would be the appointed doctors that took responsibility of management of their illness.Physicians of the two intervention centers were trained with the Guideline and their knowledge about hypertension were tested in examinations.During the intervention period physicians of control groups were required to manage the patients in line with the Guideline,meanwhile the physicians of the control centers were required to treat the patients as their routine practice.The physicians were tested in pre-and post-intervention examinations on their knowledge about hypertension.The patients were followed up at the 3^rd,6^th,9^th,12^th month,when their blood pressure were measured and associated medical information collected.EPI 5.0 was used to enter the data and SPSS 12.0 software package to do the data analysis.Results1 Control of blood pressureTo define the control of blood pressure as below 140/90mmHg,the results showed the control rate of both two intervention groups declined gradually during the intervention period.In the urban centers,at baseline there was no significant difference in classification of blood pressure between the intervention and control group,and classification of BP became more favorable gradually both in intervention and control group.However,from the 3^rd month on the classifications of BP were significantly more favorable in intervention group when compared to the control group,with the control rate of 78%for the intervention group and 42%for the control group at the end of intervention period (P＜0.01).For those people with uncontrolled blood pressure,all in the intervention group had their blood pressure at level 1,whereas 8%in the control group at level 2 and 50%at level 1.The control rate of the rural intervention group was gradually lifted,which had been significantly higher than that of the control center from the 3^rd month on(P＜0.01).Till the end of intervention period,average blood pressure of 76%patients in the intervention group were below 140/90mmHg,only 1%were at level 2 and the others at level 1; whereas 11%patients of the control group had their average blood pressure at level 2. The classification of average blood pressure of intervention group are more favorable than that of control group(P＜0.01).When merging the data of urban and rural groups,control rate of blood pressure from 9th month to the end for the intervention group reached 77%whereas the rate of the control group was 36%.The control rate of annual blood pressure of intervention group reached 74%,which was significantly higher(P＜0.01) than that of control group(30%). 2 Nonpharmacologic TreatmentAt each intervention stage,the proportion of nonpharmacologic treatment implemented by the physicians of intervention group,including diet intervention,weight control,quit smoking,exercise and stress management were significantly higher than that of control group.For example,during the intervention period 84%patients of intervention groups had been recommended balanced diet by the physicians whereas only 1%patients of control groups had been recommended that.Much higher proportion of patients was given suggestions on other nonpharmacologic treatments for the intervention group when compared to the control group.Weight of patients of rural intervention group declined during the study period.Form 6^th month visit to the end of study,average BMI value of this group has been significant lower than that of baseline(P＜0.05).There were not significant changes of weight for the rural control group as well as the urban groups.3 Pharmacologic TreatmentThe results showed the physicians of the intervention groups were more likely to use Calcium channel blockers,ACEI,diuretic than pre-intervention,whereas there were not significant changes for the control groups.At the baseline,there were 3%of patients in the urban intervention group who didn't take pharmacologic treatment,55%took combined pharmacologic treatment;whereas 2%of patients in the urban control group not take pharmacologic treatment,69%took combined treatment.4%of patients in the rural intervention group didn't take pharmacologic treatment,84%took combined treatment,whereas 1%patients in the rural control group didn't take pharmacologic treatment,81%took combined treatment. At the end,the proportion of combined treatment of both urban and rural intervention group were raised than that of the baseline,while there was no significant change in the control group.4 Health Economy EvaluationDuring the one-year intervention period,average annual antihypertensive medicine expense for one patient under control(total cost for antihypertensive medicine/ total number of patients whose blood pressure was under control) were CNY749.4 and CNY 1527.9 for the urban intervention group and control group in urban communities respectively,and CNY 466.6 and CNY 1795.2 for the rural intervention and control group respectively.Merging the urban and rural groups,the average annual medicine expense for one patient under control is CNY611.7 for intervention group and CNY1601.2 for control group.ConclusionThe results indicated that training the physicians of community with the Guideline was able to improve their practice of diagnosis and treatment,as well as cut down associated medical cost significantly.Generalizing and utilizing the Guideline is valuable for improving control rate of hypertension in China.