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Zhai X, Zhou Z, Liu G, Lu J, Zhao Y, Cao D, Zhao D, Lai S, Fan X. Catastrophic health expenditure of households with hypertension: a comparative study in China. Front Public Health 2023; 11:1176170. [PMID: 37361148 PMCID: PMC10285052 DOI: 10.3389/fpubh.2023.1176170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/18/2023] [Indexed: 06/28/2023] Open
Abstract
Objectives The aim of this study was to understand the impact of multimorbidity on catastrophic health expenditures for people with hypertension. Methods Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) in 2018, 8,342 adults were included in our analysis. Propensity score matching method was used to compare the risk of catastrophic health expenditures between the hypertension patients (treatment group) and those without any chronic disease (control group) in middle-aged and older adults. Patients with hypertension were also divided into two groups: only hypertension and multimorbidity. Results Hypertension increased the likelihood of CHE by 11.3% in older adults. Further analysis showed that hypertension alone does not increase the risk of CHE, and the risk of CHE in hypertension patients with multimorbidity was 12.9% higher than those without chronic disease. Conclusion Our study highlights the importance of healthy management of patients with only hypertension and preventing them from developing multimorbidity.
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Affiliation(s)
- Xiaohui Zhai
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Guanping Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jiao Lu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yaxin Zhao
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Dan Cao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Dantong Zhao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Sha Lai
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiaojing Fan
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Londoño Agudelo E, Battaglioli T, Díaz Piñera A, Rodríguez Salvá A, Smekens T, Achiong Estupiñán F, Carbonell García I, Van der Stuyft P. Effectiveness of a provider and patient-focused intervention to improve hypertension management and control in the primary health care setting in Cuba: a controlled before-after study. BMC PRIMARY CARE 2023; 24:10. [PMID: 36641434 PMCID: PMC9840256 DOI: 10.1186/s12875-022-01959-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Implementation research to improve hypertension control is scarce in Latin America. We assessed the effectiveness of an intervention aimed at primary care practitioners and hypertensive patients in a setting that provides integrated care through an accessible network of family practices. METHODS We conducted in Cardenas and Santiago, Cuba, a controlled before-after study in 122 family practices, which are staffed with a doctor and a nurse. The intervention comprised a control arm (usual care), an arm with a component targeting providers (hypertension management workshops), and an arm with, on top of the latter, a component targeting patients (hypertension schools). To evaluate the effect, we undertook a baseline survey before the intervention and an endline survey sixteen months after its start. In each survey, we randomly included 1400 hypertensive patients. Controlled hypertension, defined as a mean systolic and diastolic blood pressure below 140 and 90 mmHg, respectively, was the primary endpoint assessed. We performed linear and logistic regression with a Generalized Estimating Equations approach to determine if the proportion of patients with controlled hypertension changed following the intervention. RESULTS Seventy-three doctors, including substitutes, and 54 nurses from the 61 intervention family practices attended the provider workshops, and 3308 patients -51.6% of the eligible ones- participated in the hypertension schools. Adherence to anti-hypertensive medication improved from 42% at baseline to 63% at the endline in the intervention arms. Under the provider intervention, the proportion of patients with controlled hypertension increased by 18.9%, from 48.7% at baseline to 67.6% at endline. However, adding the component that targeted hypertensive patients did not augment the effect. Compared to patients in the control arm, the adjusted OR of having controlled hypertension was 2.36 (95% CI, 1.73-3.22) in the provider and 2.00 (95% CI, 1.68-2.37) in the provider plus patient intervention arm. CONCLUSIONS The intervention's patient component remains to be fine-tuned. Still, we demonstrate that it is feasible to substantially improve hypertension outcomes by intervention at the primary care level, despite an already relatively high control rate.
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Affiliation(s)
- Esteban Londoño Agudelo
- grid.412881.60000 0000 8882 5269Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia, Calle 62 #52-59, Medellín, Colombia ,grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University. Campus UZ-Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium ,grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, St. Rochusstraat 43, 2000 Antwerp, Belgium ,grid.411140.10000 0001 0812 5789Facultad de Medicina, Universidad CES, Calle 10A #22-04, Medellín, Colombia
| | - Tullia Battaglioli
- grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, St. Rochusstraat 43, 2000 Antwerp, Belgium
| | - Addys Díaz Piñera
- grid.493388.d0000 0004 0461 1191Centro de Epidemiología y Salud Ambiental, Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), Infanta No. 1158 e/ Llinás y Clavel, Centro Habana, 10300 La Habana, Cuba
| | - Armando Rodríguez Salvá
- grid.493388.d0000 0004 0461 1191Centro de Epidemiología y Salud Ambiental, Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), Infanta No. 1158 e/ Llinás y Clavel, Centro Habana, 10300 La Habana, Cuba
| | - Tom Smekens
- grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, St. Rochusstraat 43, 2000 Antwerp, Belgium
| | | | - Isabel Carbonell García
- Centro Provincial de Higiene y Epidemiología, Calle J No. 1 entre 1ra y 2da Reparto Sueño, Santiago de Cuba, Cuba
| | - Patrick Van der Stuyft
- grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University. Campus UZ-Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Peters MA, Noonan CM, Rao KD, Edward A, Alonge OO. Evidence for an expanded hypertension care cascade in low- and middle-income countries: a scoping review. BMC Health Serv Res 2022; 22:827. [PMID: 35761254 PMCID: PMC9235242 DOI: 10.1186/s12913-022-08190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background With nearly 90% of annual hypertension-related deaths occurring in low- and middle-income countries (LMICs), there is an urgent need to measure the coverage of health services that effectively manage hypertension. However, there is little agreement on how to define effective coverage and the existing hypertension care cascade (hypertension prevalence, percent aware, percent treated, and percent controlled) does not account for the quality of care received by patients. This study reviews definitions of effective coverage and service quality for hypertension management services and proposes an expanded hypertension care cascade to improve measurement of health systems performance. Methods A systematic scoping review of literature published in six electronic databases between January 2000 and October 2020 identified studies that defined effective coverage of hypertension management services or integrated dimensions of service quality into population-based estimates of hypertension management in LMICs. Findings informed an expanded hypertension care cascade from which quality-adjusted service coverage can be calculated to approximate effective coverage. Results The review identified 18 relevant studies, including 6 that defined effective coverage for hypertension management services and 12 that reported a measure of service quality in a population-based study. Based on commonly reported barriers to hypertension management, new steps on the proposed expanded care cascade include (i) population screened, (ii) population linked to quality care, and (iii) population adhering to prescribed treatment. Conclusion There is little consensus on the definition of effective coverage of hypertension management services, and most studies do not describe the quality of hypertension management services provided to populations. Incorporating aspects of service quality to the hypertension care cascade allows for the calculation of quality-adjusted coverage of relevant services, enabling an appropriate measurement of health systems performance through effective coverage. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08190-0.
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Affiliation(s)
- Michael A Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Caitlin M Noonan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Krishna D Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Olakunle O Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Londoño Agudelo E, Pérez Ospina V, Battaglioli T, Taborda Pérez C, Gómez-Arias R, Van der Stuyft P. Gaps in hypertension care and control: a population-based study in low-income urban Medellin, Colombia. Trop Med Int Health 2021; 26:895-907. [PMID: 33938098 PMCID: PMC8453502 DOI: 10.1111/tmi.13599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess hypertension prevalence and the extent and associated factors of hypertension diagnosis, follow-up, treatment and control gaps in low-income urban Medellin, Colombia. METHODS We randomly sampled 1873 adults aged 35 or older. Unaware hypertensive individuals were defined as those without previous diagnosis whose average blood pressure was equal to or above 140/90 mmHg. For aware hypertensive patients, control was delimited as average blood pressure below 140/90 if under 59 years old or diabetic, and as less than 150/90 otherwise. We used logistic regression to identify care gap-associated factors. RESULTS Hypertension prevalence was 43.5% (95% CI 41.2-45.7). We found 28.2% aware and 15.3% unaware hypertensive individuals, which corresponds to a 35.1% (95% CI 31.9-38.5) underdiagnosis. This gap was determined by age, sex, education and lifestyle factors. 14.4% (95% CI 11.6-17.6) of aware hypertensive patients presented a follow-up gap, 93.4% (95% CI 90.9-95.2) were prescribed antihypertensive drugs, but 38.9% (95% CI 34.7-43.3) were not compliant. The latter was strongly associated with follow-up. The hypertension control gap in aware hypertensive patients, 39.0% (95% CI: 34.9-43.2), was associated with being older, having diabetes, weakly adhering to pharmacological treatment and receiving poor non-pharmacological advice. Overall, 60.4% (95% CI 57.0-63.8) of aware and unaware hypertensive participants had either diagnosed but uncontrolled or undiagnosed hypertension. CONCLUSIONS We found high hypertension prevalence coupled with, from an international perspective, encouraging awareness and control figures. Still, there remains ample room for improvement. Our findings can assist in designing integrated primary healthcare measures that further strengthen equitable and effective access to hypertension care and control.
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Affiliation(s)
- Esteban Londoño Agudelo
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.,Facultad de Medicina, Universidad CES, Medellín, Colombia
| | | | - Tullia Battaglioli
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Rubén Gómez-Arias
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.,Facultad de Medicina, Universidad CES, Medellín, Colombia
| | - Patrick Van der Stuyft
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Londoño Agudelo E, García Fariñas A, Pérez Ospina V, Taborda Pérez C, Villacrés Landeta T, Battaglioli T, Gómez Arias R, Van der Stuyft P. Out-of-pocket expenditure for hypertension care: a population-based study in low-income urban Medellin, Colombia. Glob Health Action 2021; 13:1806527. [PMID: 32867605 PMCID: PMC7480425 DOI: 10.1080/16549716.2020.1806527] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Hypertension requires life-long medical care, which may cause economic burden and even lead to catastrophic health expenditure. Objective To estimate the extent of out-of-pocket expenditure for hypertension care at a population level and its impact on households’ budgets in a low-income urban setting in Colombia. Methods We conducted a cross-sectional survey in Santa Cruz, a commune in the city of Medellin. In 410 randomly selected households with a hypertensive adult, we estimated annual basic household expenditure and hypertension-attributable out-of-pocket expenditure. For socioeconomic stratification, we categorised households according to basic expenditure quintiles. Catastrophic hypertension-attributable expenditure was defined as out-of-pocket expenditure above 10% of total household expenditure. Results The average annual basic household expenditure was US dollars at purchasing power parity (USD-PPP) $12,255.59. The average annual hypertension-attributable out-of-pocket expenditure was USD-PPP $147.75 (95% CI 120.93–174.52). It was incurred by 73.9% (95% CI 69.4%-78.1%) of patients, and consisted mainly of direct non-medical expenses (76.7%), predominantly for dietary requirements prescribed as non-pharmacological treatment and for transport to attend health care consultations. Medical out-of-pocket expenditure (23.3%) was for the most part incurred for pharmacological treatment. Hypertension-attributable out-of-pocket expenditure represented on average 1.6% (95% CI 1.3%-1.9%) of the total annual basic household expenditure. Eight households (2.0%; 95% CI 1.0%-3.8%) had catastrophic health expenditure; six of them belonged to the two lowest expenditure quintiles. Payments related to dietary requirements and transport to consultations were critical determinants of their catastrophic expenditure. Conclusions Out-of-pocket expenditure for hypertension care is moderate on average, but frequent, and mainly made up of direct non-medical expenses. Catastrophic health expenditure is uncommon and affects primarily households in the bottom socioeconomic quintiles. Financial protection should be strengthened by covering the costs of chronic diseases-related dietary requirements and transport to health services in the most deprived households. Abbreviations NCDs: Non-communicable diseases; LMICs: Low and middle-income countries; WHO: World Health Organization; HTN: hypertension; CVDs: Cardiovascular diseases; OOPE: out-of-pocket expenditure; USD-PPP: US dollars at purchasing power parity; CI: Confidence interval
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Affiliation(s)
- Esteban Londoño Agudelo
- Department of Public Health, Institute of Tropical Medicine , Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University , Ghent, Belgium.,Facultad de Medicina, Universidad CES , Medellin, Colombia.,Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia , Medellín, Colombia
| | - Anaí García Fariñas
- Dirección de Investigación Clínica y Evaluación de Impacto, Instituto Finlay de Vacunas , La Habana, Cuba
| | | | | | | | - Tullia Battaglioli
- Department of Public Health, Institute of Tropical Medicine , Antwerp, Belgium
| | - Rubén Gómez Arias
- Facultad de Medicina, Universidad CES , Medellin, Colombia.,Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia , Medellín, Colombia
| | - Patrick Van der Stuyft
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University , Ghent, Belgium
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