Health system strengthening and hypertension management in China

Abstract

BackgroundNon-communicable diseases are the leading causes of global burden of diseases, and hypertension is one of the most important risk factors. Hypertension prevalence doubled in China in the past decade and affects more than 300 million Chinese people. In the review we systematically searched peer-reviewed publications that link health system level factors with hypertension management in China and provide the current knowledge on how to improve a country’s health system to manage the hypertension epidemic.MethodsA framework was developed to guide the review. The database of PubMed, CNKI were systematically searched from inception to April 13, 2016. Two authors independently screened the searched results for inclusion, conducted data extraction and appraised the quality of studies. Key findings were described according to the framework.FindingsFive hundred seventy-two publications were identified, where 11 articles were left according to the inclusion and exclusion criteria. The study periods range from 2010 to 2015. All about 11 researches linked health system factors to the outcome of hypertension management. And the outcomes were just focused on the awareness, treatment and control of hypertension but not hypertension incidence. One study is about the role of health system governance, investigating the performance of different organized community health care centers; three studies were about health financing comparing differences in insurance coverage; three studies were about health information practicing the hypertension guidelines of China or the WHO, and the rest three about mechanisms of health service delivery. No researches were identified about physical resources for health and human resources for health.ConclusionsHypertension prevalence has been rising rapidly in China and the management of hypertension in China is a detection problem rather than treatment problem. Limited evidence shows the positive effect of health system factors on hypertension management and joint efforts from health system and epidemiological researchers are warranted to extend knowledge in this area.Electronic supplementary materialThe online version of this article (doi:10.1186/s41256-016-0013-8) contains supplementary material, which is available to authorized users.

Temporal Trends and Geographic Disparity in Hypertension Care in China

“…This quality gap may be the result of weakness in the service delivery system; the split between preventive care and primary care provision systems may hinder the continuity and coordination of prevention, treatment, and effective control of hypertension. 21,29,30 Unlike hypertensive care patients in most developed countries, those in China are still receiving care from different providers: clinical care is provided by primary care physicians, preventive care and management by public health physicians, community-based intervention by community health workers, and patient education in both primary care facilities and the community. 31,32 Efforts in health system strengthening should be focused on bringing the different services together; offering hypertensive patients accessible, continuous, and coordinated care; and improving the quality of hypertension management in China.…”

Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States

“…China has the opportunities to mimic the success seen in the United States, given the country's health infrastructure, particularly in primary care. Free screening and routine management of hypertension have been provided since China's 2009 health reform 24, 25. Efforts are needed to scale up screening and use of antihypertensive medications as a part of expanding and improving primary care.…”

Prevalence and treatment of hypertension in China: impacts of 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline

“…The prevalence of hypertension in China has been rising rapidly during the past two decades [14,15]. Pooled data from 178 studies between 1999 and 2014 revealed that the overall prevalence was 28.9% [16].…”