Author: Qiang Tu
Tu, Qiang, 2019 Hypertension management for older people with diabetes in Nanchang, China: from evidence-base to outcomes, Flinders University, College of Nursing and Health Sciences
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Background
Hypertension is the most common health condition that affects up to 82% of people living with diabetes. The prevalence of hypertension increases with aging. China possesses the largest number of older people living with multimorbidity of hypertension and diabetes in the world. However, the primary care system is largely underdeveloped to respond to the health care needs of this population. Hospital-centred care services are widely used in managing hypertension for this population resulting in fragmental care and lack of follow-up support in the community.
Aims
The overall aim of the project was to develop and evaluate an evidence-based hypertension management program for older people with diabetes in Nanchang, China. The specific aims were:
Aim 1: to gain health professionals’ consensus on the applicability of an evidence-based hypertension management program for older people with diabetes who were ready to be discharged from hospital and required follow-up support in the community; and
Aim 2: to test a hypothesis that the evidence-based hypertension management program can improve blood pressure control in people aged 60 and over with diabetes as compared to usual care.
Methods
This project included Study 1 and Study 2 to address each of the aims. In study 1, a modified Delphi study with an expert panel in Nanchang, China was conducted. In Study 2, a 6-month cluster randomised controlled trial was undertaken to test the hypothesis stated in the Aim 2.
Results
In Study 1, 70 health professionals from four hospitals and six Community Health Centers participated in the Delphi study. The participants were multidisciplinary experts with experience in the study area. The questionnaire used in round one of the Delphi study described an evidence-based hypertension management program identified in a literature review. Participants achieved consensus on the program within two rounds.
In study 2, a cluster randomized controlled trial involving ten wards from four hospitals were randomly allocated to either intervention group (N=5) or usual care group (N=5). A total of 270 older people (135 in each group) were recruited into the trial. The mean age of participants was 70.9 (SD=5.8) years and the average duration of diabetes and hypertension diagnosis was 9.4 (SD=6.0) and 9.3 (SD=6.8) years respectively. On the completion of the trial, the intervention group demonstrated a statistically significant decrease of a mean systolic blood pressure of 10.7 mmHg (95%CI: -14.2 to -7.1, P<0.001) and a mean diastolic blood pressure of 4.1 mmHg (95% CI: -6.2 to -2.2, P<0.001), compared to the usual care group. Findings also demonstrated significant improvements of HbA1c, LDL, hypertension knowledge, diabetes knowledge, treatment adherence, quality of life, reduced adverse events and hospital readmission in the intervention group compared to the usual care group. There was no significant difference on HDL between the two groups.
Conclusion
An evidence-based hypertension management program built on collaboration of hospital and Community Health Centers and targeted individualized care needs improved hypertension control for older people with diabetes. Findings have implications for policy, resource and care services development.
Keywords: Hypertension, Diabetes, Cluster randomized controlled trial, Collaborative care, Primary health system
Subject: Ageing Studies thesis
Thesis type: Doctor of Philosophy
Completed: 2019
School: College of Nursing and Health Sciences
Supervisor: Lily Xiao