The effect of hypertension and diabetes management in Southwest China: a before- and after-intervention study.

Abstract

BACKGROUND: Non-communicable diseases are leading causes of disease burden in middle income countries. Little evidence exists to determine if the primary healthcare system can effectively manage non-communicable diseases. The purpose of this study was to examine the effectiveness of hypertension and diabetes management by the primary healthcare system. METHODS: We used individual level data from the 2009 National Basic Public Health Services System to assess the effectiveness of hypertension and diabetes interventions on fasting plasma glucose, and blood pressure. We analyzed the associations between fasting plasma glucose, systolic or diastolic blood pressure and risk factors. The estimated average intervention effect on data balanced with confounding variables was assessed. RESULTS: 9543 individuals who had data for fasting plasma glucose, systolic blood pressure and diastolic blood pressure were included in this analysis. This study included 6681 patients with hypertension and 2222 with diabetes. The intervention lowered mean fasting plasma glucose by 0.5 mmol/L (0.4-0.6), lowered mean systolic blood pressure by 3.5 mm Hg (3.2-3.7), and lowered diastolic blood pressure by 2.9 mm Hg (2.7-3.2). Individuals who received medicinal treatment had 1.3 mmHg (0.8 to 1.8, P<0.01) lower diastolic blood pressure and 0.6 mmol/L (0.5-0.8, P<0.01) lower fasting plasma glucose than those who did not receive medicine. Generalized linear model indicated that medicinal treatment and baseline systolic blood pressure were significant positive predictors of change in systolic blood pressure. Age, living in urban areas and diabetic complications were significant negative predictors of change for systolic blood pressure. CONCLUSION: The National Basic Public Health Services System in China using trained community healthcare workers and well-established guidelines can be effectively implement non-communicable disease prevention and management care paradigms.