Urban-rural disparity in the utilization of national community-based hypertension monitoring service-results from the China Health and Retirement Longitudinal Study, 2015

The impact of hypertension follow-up management on the choices of signing up family doctor contract services: does socioeconomic status matter?

BACKGROUND

This study aimed to explore the association between hypertension follow-up management and family doctor contract services, as well as to examine whether socioeconomic status (SES) had an interaction effect on this relationship among older adults in China.

METHODS

We used data from the sixth National Health Service Survey of Shandong Province, China, including 3,112 older adults (age ≥ 60 years) with hypertension in 2018. Logistic regression models and a margins plot were used to analyze the role of SES in the relationship between hypertension follow-up management and family doctor contract services.

RESULTS

The regular hypertension follow-up management rate and family doctor contracting rate were 81.8% and 70.9%, respectively, among older adults with hypertension. We found that participants with regular hypertension follow-up management were more likely to sign family doctor contract services (OR=1.28, 95%CI: 1.04, 1.58, P=0.018). The interaction effect occurred in the groups who lived in rural areas (OR=1.55, 95%CI: 1.02, 2.35), with high education level (OR=0.53, 95%CI: 0.32, 0.88) and had high incomes (OR=0.53, 95%CI: 0.35, 0.81).

CONCLUSIONS

Our findings suggested that regular hypertension follow-up management was associated with family doctor contract services and SES influenced this relationship. Primary health care should improve the contracting rate of family doctors by strengthening follow-up management of chronic diseases. Family doctors should focus on improving services quality and enriching the content of service packages especially for older adults with higher income and education level.

The Association of Age at Diagnosis of Hypertension with Cognitive Decline: the China Health and Retirement Longitudinal Study (CHARLS)

AIM

This study investigated whether an individual's age at diagnosis of hypertension, which is associated with a decline in cognitive performance in the China Health and Retirement Longitudinal Study (CHARLS) participants.

METHODS

Our analysis was based on the CHARLS with baseline data collected between 2011 and 2018. We randomly selected a control participant for each hypertensive participant using propensity score. The cohort comprised 2413 individuals with hypertension and 2411 controls. Participants were divided into three groups as follows: non-hypertension, hypertension diagnose ≥55 years, and hypertension diagnose <55 years. Cognitive performance was measured in both visits and evaluated by the scores of the memory, executive function, and orientation and global cognitive.

RESULTS

After multivariable adjustment, individuals with hypertension diagnosed <55 years had a significantly faster cognitive decline in memory test (β (95% CI, -1.117 [-1.405, -0.83]), orientation test (β (95% CI, -1.273 [-1.348, -1.198]) and global cognitive (β (95% CI, -1.611 [-1.744, -1.478]) compared with the corresponding controls. A longer hypertension duration was associated with worse memory test (β (95% CI, -0.069 [-0.113 to -0.025]). Among treated individuals, blood pressure control at baseline was inversely associated with the decline in orientation test (β (95% CI, -0.659 [-0.939, -0.380]), orientation test (β (95% CI, -0.259[-0.365, -0.153])and global cognitive (β (95% CI, -0.124 [-0.162, -0.086]).

CONCLUSIONS

Our findings suggest that hypertension diagnosed in mid-life is associated with worse cognition compared to late life. Besides, longer duration of diagnosis is associated with worse memory test. In addition to hypertension, pressure control might be critical for the preservation of cognitive function.

Telescreening satisfaction: disparities between individuals with diabetic retinopathy and community health center staff

Background

The success of telescreening and the management of diabetic retinopathy (DR) in communities depends on stakeholder satisfaction, including both individuals with diabetes and community health center (CHC) staff. In this study, we investigated the satisfaction of both individuals with vision-threatening DR (VTDR) and CHC staff within the Shanghai Eye Disease Study (SEDS) comprehensive system for managing diabetic eye diseases at the primary care level.

Methods

The cross-sectional survey of patients receiving the service included 3,817 respondents with VTDR and focused on their satisfaction with the SEDS system, including the telescreening process, speed of feedback, interpretation of results, increased awareness of related diseases, and eye care services. The survey of the providers included 234 CHC staff respondents and focused on their satisfaction and the main barriers encountered during the implementation of the system. Sociodemographic characteristics and perceived barriers related to satisfaction were identified by conducting univariate and multivariate logistic regression analyses.

Results

The overall satisfaction of service recipients was 96.0%, and 75.8% of them were willing to undergo future telescreening for DR. The convenience of telescreening, organization of telescreening, and improvement in related disease awareness significantly correlated with satisfaction. Only 48.3% of the providers were satisfied with the SEDS system. The most frequently mentioned barriers to the development of the system were the inadequate levels of staffing (particularly technical staff), insufficient funding, and incomplete information transmission systems.

Conclusions

Disparities between high patient satisfaction and low provider satisfaction with the SEDS system were mainly related to the current weak level of ophthalmic expertise in the CHCs and the low awareness of screening for diabetic eye diseases among both patients and providers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07500-w.

Heterogeneity in longitudinal trajectories of cognitive performance among middle-aged and older individuals with hypertension: Growth mixture modeling across an 8-year cohort study

Hypertension is one of the most prevalent chronic conditions and has been proven to be related to cognitive function. However, there is no evidence regarding the heterogeneity in cognitive trajectories among persons with hypertension. The aims of the current study were to characterize the heterogeneity in longitudinal trajectories of cognitive performance among Chinese middle-aged and older individuals with hypertension and to explore the potential determinants of trajectory memberships. Data from the 2011 to 2018 Chinese Health and Retirement Longitudinal Study (CHARLS) were utilized. Two cognitive measures of executive function and episodic memory were assessed, and conditional growth mixture modeling (GMM) was performed to identify the trajectories of cognitive performance and explore the related factors of cognitive change. The findings revealed three trajectory classes of executive function (stable, sharp decline, smooth decline) and two trajectory classes of episodic memory (stable, decline). Individuals with hypertension who had a higher educational level, moderate nighttime sleep duration, and lower depressive symptoms as well as those who reported consuming alcohol at least once a month were more likely to belong to the optimal stable executive function group. Subjects with a higher educational level, adequate daytime napping duration, and higher BMI were more likely to exhibit stable episodic memory over time. Other factors, including age, sex, community type, marital status, and hypertension treatment, exhibited class-specific effects on growth parameters of cognitive trajectory. Targeting intervention designation is proposed to ameliorate the burdens of cognitive impairment among individuals with hypertension.

A cross-sectional study on the ability of physicians to hypertension management in China's Sichuan Tibetan rural area

This study aimed to investigate the hypertension management abilities of rural physicians in a high‐altitude Tibetan area. A cross‐sectional survey was conducted in the Ganzi Tibetan Autonomous Prefecture, China, in October 2020. Information about healthcare resources in local medical institutions, along with the knowledge, attitudes, practices, and training status of primary care physicians, was collected. Limited resources were observed in terms of equipment, drugs, and personnel in the 18 township hospitals included. A total of 132 physicians participated in this survey. The scores for hypertension‐related knowledge, attitudes toward hypertension management, routine practice ability, priority given to hypertension, and confidence in performing certain tasks were 32.60%, 67.40%, 18.90%, 65.15%, and 35.60%, respectively. The most concerning issues lay in the ignorance of the healthy lifestyle, undervaluation of cardiovascular risks, and lack of confidence in optimally performing management activities. Only 9.85% of the physicians received more than 24 days of training per year; 28.79% preferred a longer training time. While training was generally provided in conference sessions (63.64% of current training programs), physicians preferred remote education (55.30%), and on‐site guidance (46.21%) from professionals. The current training was centered around clinical skills (61.36%) and was identified as a major training requirement by the physicians surveyed (80.30%). This survey suggests that the medical resources may not be effective, with deficiencies present in the knowledge and practices of primary care physicians in the Sichuan Tibetan area. Hypertension education and skill‐development courses based on the specific issues identified should be provided to these physicians in the future.