■中国的国家基本公共卫生服务一揽子计划(NEPHSP)旨在在初级卫生保健水平上促进所有人的健康,并重点关注高血压和2型糖尿病(T2DM)。然而,现有的量化初级卫生保健中高血压和T2DM的护理级联的现代数据有限.
■这项横断面研究涉及从NEPHSP常规收集的数据的个体水平链接,健康保险索赔和医院电子健康记录,来自中国四个不同的地区,包括西陵区(中国中部),汶川县(西部),阿城区和胶区(北部)。我们首先比较了年龄≥35岁并有记录的高血压和T2DM诊断的人数与来自流行病学数据的预期人数。然后,我们构建了护理级联来评估NEPHSP中登记的百分比(1),(2)坚持NEPHSP的后续护理,(3)接受药物治疗,(4)高血压和/或T2DM得到控制。
■在四个地区,从任何数据来源诊断为高血压和T2DM的≥35岁人群的总人数分别为149,176和50,828.估计为高血压和T2DM预期总数的46.0%(95%置信区间[CI]:45.8%-46.2%)和45.6%(95%CI:45.3%-45.9%),分别。在那些确诊的人中,65.4%(95%CI:65.1%-65.6%)合并高血压和66.1%(95%CI:65.7%-66.5%)合并T2DM纳入NEPHSP,分别,其中54.8%(95%CI:54.5%-55.2%)的高血压患者和64.7%(95%CI:64.1%-65.2%)的T2DM患者坚持所需的服务。在那些注册的人中,高血压和T2DM的总治疗率分别为70.8%(95%CI:70.6%-71.1%)和82.2%(95%CI:81.8%-82.6%).在接受治疗的人中,另外80.9%(95%CI:80.6%-81.2%)的高血压患者和73.9%(95%CI:73.3%-74.4%)的T2DM患者达到控制.这些结果在不同地区差异很大,北部站点的入学率相对较高,而中央站点的控制率较高。
■在中国这四个地区,高血压和T2DM的检出率和控制率均不理想。需要进一步的策略来提高人们对NEPHSP的入学率和依从性,并加强护理提供过程。值得注意的是,我们对每个地区的诊断率的估计是基于国家一级的大型流行病学数据。由于区域差异造成的潜在偏差,对这些数据的解释需要谨慎。
■本研究由国家卫生与医学研究理事会(NHMRC)全球慢性病联盟(APP1169757)资助,国家自然科学基金(72074065).
UNASSIGNED: China\'s National Essential Public Health Service Package (NEPHSP) aims to promote health for all at the primary health care level and includes a focus on hypertension and type-2 diabetes mellitus (T2DM). However, there are limited contemporary data to quantify the care cascades of hypertension and T2DM in primary health care.
UNASSIGNED: This cross-sectional study involved individual level linkage of routinely collected data from the NEPHSP, health insurance claims and hospital electronic health records, from four diverse regions in China, including Xiling District (central China), Wenchuan County (western), Acheng District and Jiao District (northern). We first compared numbers of people aged ≥35 with a recorded diagnosis of hypertension and T2DM against expected numbers derived from epidemiological data. We then constructed care cascades to assess the percentages (1) enrolled in the NEPHSP, (2) adherent to the follow-up care of NEPHSP, (3) receiving medication treatment, and (4) having hypertension and/or T2DM controlled.
UNASSIGNED: In the four regions, the total numbers of people aged ≥35 diagnosed of hypertension and T2DM from any data source were 149,176 and 50,828, respectively. This was estimated to be 46.0% (95% confidence interval [CI]: 45.8%-46.2%) and 45.6% (95% CI: 45.3%-45.9%) of the expected totals for hypertension and T2DM, respectively. Among those diagnosed, 65.4% (95% CI: 65.1%-65.6%) with hypertension and 66.1% (95% CI: 65.7%-66.5%) with T2DM were enrolled in the NEPHSP, respectively, in which 54.8% (95% CI: 54.5%-55.2%) with hypertension and 64.7% (95% CI: 64.1%-65.2%) with T2DM were adherent to the required services. Among those enrolled, the overall treatment rates were 70.8% (95% CI: 70.6%-71.1%) for hypertension and 82.2% (95% CI: 81.8%-82.6%) for T2DM. Among those treated, a further 80.9% (95% CI: 80.6%-81.2%) with hypertension and 73.9% (95% CI: 73.3%-74.4%) with T2DM achieved control. These results varied considerably across regions, with the northern sites showing relatively higher enrolment rates while the central site had higher control rates.
UNASSIGNED: Detection and control rates for hypertension and T2DM are suboptimal in these four regions of China. Further strategies are needed to improve people\'s enrolment in and adherence to the NEPHSP and strengthen care delivery processes. Of note, our estimations of the diagnosis rates for each region are based on national level large epidemiological data. The interpretation of these data needs caution due to potential bias caused by regional variations.
UNASSIGNED: This study is funded by National Health and Medical Research Council (NHMRC) Global Alliance for Chronic Diseases funding (APP1169757), and National Natural Science Foundation of China (72074065).