背景:印度高血压控制倡议(IHCI)强调分散的以患者为中心的护理,以促进公共医疗机构的高血压控制。我们记录了权力下放过程,按设施类型划分的注册模式,旁遮普邦和马哈拉施特拉邦九个地区的治疗结果,印度,从2018年到2022年。
方法:我们使用世界卫生组织(WHO)卫生系统支柱框架,详细介绍了高血压护理从较高机构向健康与保健中心(HWC)的转变。我们回顾了来自两个州9个地区的4,045个公共设施的高血压治疗记录,关注包括登记号在内的指标,受控制的比例,不受控制的血压(BP),以及被照顾者错过的探视。
结果:权力下放过程涉及培训,治疗方案规定,监督,和监测。在2018-2021年登记患有高血压的394,038人中,69%在2022年接受护理。2022年,近一半的受护理者(129,720/273,355)接受了HWC的治疗。对地区医院高血压患者的护理(14%),社区卫生中心(20%),初级保健中心(24%)下放给HWC。整体BP控制从2019年的20%(4,004/20,347)上升至2022年的58%(157,595/273,355),错访从2019年的61%(12,394/20,347)下降至2022年的26%(70,894/273,355)。这种趋势在这两个州是一致的。与其他设施类型相比,HWC在整个研究期间表现出最高的BP控制和最低的错过访视。
结论:我们记录了在四年中分散获得高血压治疗和改善治疗结果的增加。我们建议在印度其他地区实施HWC的高血压护理,以改善BP控制。
BACKGROUND: The India Hypertension Control Initiative (IHCI) emphasizes decentralized patient-centric care to boost hypertension control in public healthcare facilities. We documented the decentralization process, enrolment pattern by facility type, and treatment outcomes in nine districts of Punjab and Maharashtra states, India, from 2018-2022.
METHODS: We detailed the shift in hypertension care from higher facilities to Health and Wellness Centres (HWCs) using the World Health Organization (WHO) health system pillar framework. We reviewed hypertension treatment records in 4,045 public facilities from nine districts in the two states, focusing on indicators including registration numbers, the proportion of controlled, uncontrolled blood pressure (BP), and missed visits among those under care.
RESULTS: The decentralization process involved training, treatment protocol provision, supervision, and monitoring. Among 394,038 individuals registered with hypertension from 2018-2021, 69% were under care in 2022. Nearly half of those under care (129,720/273,355) received treatment from HWCs in 2022. Care of hypertensive individuals from district hospitals (14%), community health centres (20%), and primary health centres (24%) were decentralized to HWCs. Overall BP control rose from 20% (4,004/20,347) in 2019 to 58% (157,595/273,355) in 2022, while missed visits decreased from 61% (12,394/20,347) in 2019 to 26% (70,894/273,355) in 2022. This trend was consistent in both states. HWCs exhibited the highest BP control and the lowest missed visits throughout the study period compared to other facility types.
CONCLUSIONS: We documented an increase in decentralized access to hypertension treatment and improved treatment outcomes over four years. We recommend operationalizing hypertension care at HWCs to other districts in India to improve BP control.