Full coverage for hypertension drugs in rural communities in China
Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA 30341. E-mail: . The American journal of managed care
(Impact Factor: 2.26).
Background: The control rate for hypertension is unacceptably low worldwide, and poor adherence to medication is a primary reason. Objectives: To evaluate the impact of full coverage for hypertension drugs on adherence to medication, medical costs, and hypertension control in Shandong Province, China. Methods: In November 2009, we interviewed 110 hypertensive patients who had been participating in a free medication program since May 2008 and 241 hypertensive patients who were not participating. We used a 1:1 propensity-score matching technique to obtain matched samples of 102 program participants (intervention) and 102 nonparticipants (control). We used univariate analysis to compare patient drug-taking behaviors, medical costs, and hypertension control between the 2 groups. Results: All intervention patients took > 1 drugs for hypertension control and 93% of them took > 3 such drugs, 15 control patients (15%) did not take any, and only 39% took 3 or more (P < .001). Three-fourths (75%) of the intervention patients took the prescribed drugs regularly, whereas 66% of the control group (P = .034) did so. Participation in the program was associated with lower annual out-of-pocket medical costs both overall and for outpatient services (P < .001 for both). Conclusions: Low-income rural residents in China receiving free drugs had enhanced medication adherence and reduced total medical costs. Providing hypertension drugs at no charge may be a promising strategy for preventing costly cardiovascular events associated with hypertension in China and other parts of the world with growing rates of cardiovascular disease.
Available from: Will Maimaris
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ABSTRACT: Hypertension (HT) affects an estimated one billion people worldwide, nearly three-quarters of whom live in low- or middle-income countries (LMICs). In both developed and developing countries, only a minority of individuals with HT are adequately treated. The reasons are many but, as with other chronic diseases, they include weaknesses in health systems. We conducted a systematic review of the influence of national or regional health systems on HT awareness, treatment, and control.
Eligible studies were those that analyzed the impact of health systems arrangements at the regional or national level on HT awareness, treatment, control, or antihypertensive medication adherence. The following databases were searched on 13th May 2013: Medline, Embase, Global Health, LILACS, Africa-Wide Information, IMSEAR, IMEMR, and WPRIM. There were no date or language restrictions. Two authors independently assessed papers for inclusion, extracted data, and assessed risk of bias. A narrative synthesis of the findings was conducted. Meta-analysis was not conducted due to substantial methodological heterogeneity in included studies. 53 studies were included, 11 of which were carried out in LMICs. Most studies evaluated health system financing and only four evaluated the effect of either human, physical, social, or intellectual resources on HT outcomes. Reduced medication co-payments were associated with improved HT control and treatment adherence, mainly evaluated in US settings. On balance, health insurance coverage was associated with improved outcomes of HT care in US settings. Having a routine place of care or physician was associated with improved HT care.
This review supports the minimization of medication co-payments in health insurance plans, and although studies were largely conducted in the US, the principle is likely to apply more generally. Studies that identify and analyze complexities and links between health systems arrangements and their effects on HT management are required, particularly in LMICs. Please see later in the article for the Editors' Summary.
PLoS Medicine 07/2013; 10(7):e1001490. DOI:10.1371/journal.pmed.1001490 · 14.43 Impact Factor
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ABSTRACT: Hypertension and associated chronic diseases impose enormous and growing health and economic burdens worldwide. The objective of this study was to investigate the cost-effectiveness (CE) of a hypertension control program in China.
We collected information on program costs and health outcomes in three community health centers over a 1-year period. The participants were 4902 people with hypertension (systolic blood pressure [SBP] ≥140 mm Hg and/or diastolic blood pressure [DBP] ≥90 mm Hg, or on hypertension medication) aged 18 years and older. The SBP and DBP changes in the populations were estimated from a random sample of 818 participants by conducting face-to-face interviews and physical examinations. We derived CE measures based on the costs and effects on health outcomes.
The total cost of implementing the intervention was Renminbi (RMB) 240 772 yuan (US$35 252), or 49 yuan (US$7.17) per participant in 2009. On average, SBP decreased from 143 to 131 mm Hg (P < .001) and DBP decreased from 84 to 78 mm Hg (P < .001), the SBP decreases ranged from 7.6 to 17.8 mm Hg and DBP decreases ranged from 3.9 to 8.3 mm Hg. CE ratios ranged from RMB 3.6 to 5.0 yuan (US$0.53-US$0.73) per person per mm Hg SBP decrease, and from RMB 6.3 to 9.7 yuan (US$0.92-US$1.42) per person per mm Hg DBP decrease.
Per capita costs varied widely across the communities, as did changes in SBP and DBP, but CE was similar. The findings suggest (a) a positive correlation between per capita costs and program effectiveness, (b) differences in intervention levels, and (c) differences in health status. CE results could be helpful to policy makers in making resource allocation decisions.
Journal of primary care & community health 07/2013; 4(3):195-201. DOI:10.1177/2150131912470459
Available from: Slavomira Filipova
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ABSTRACT: Arterial hypertensionis an important worldwide health problem. Its relevance relatesboth to the high incidence and prevalence in all adult communities and to the high risk of serious and potentially fatal cardiovascular events dueto hypertension. Resistant hypertension is defined as a blood pressure (BP) remaining above goal (>140/90 mm Hg) despite the use of at least 3 optimally dosed antihypertensive drugs from different classes, with one of the drugs being a diuretic. The exact prevalence of RH is unknown, but it is generally estimated at 10-20% of hypertensive patients. The aim of this review article is to address several important issues: (1) How to diagnose true RH ? (2) What is the optimal state-of-art management of RH in the light of the most recent scientific evidence and what is the role of various medical specialties in this process ? (3) Are there any country specific issues related to diagnosing and treating of RH in Kazakhstan and if so, how to tackle them ?Long-lasting resistant hypertension increases by 50-80% the risk of major cardiovascular events (myocardial infarction, stroke) and end-organ damage. (heart failure, vascular dementia, chronic kidney disease). Adherence to well chosen therapy is the key factor in achieving blood pressure control and this must be based on adequate patient education and universal access to drug therapy. Thus, early recognition and appropriate management of RH must be among the top priorities of all public health initiatives to reduce the burden of cardiovascular diseases (Tab. 2, Fig. 1, Ref. 31) Keywords: resistant arterial hypertension, diagnosis, treatment.
Bratislavske lekarske listy 05/2014; 115(5):280-6. DOI:10.4149/BLL_2014_058 · 0.44 Impact Factor
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