Abstract 182: The Impact of National and Regional Health Systems Arrangements on Hypertension Awareness, Treatment and Control: a Systematic Literature Review
Notice bibliographique
Résumé
Background: Around a billion people worldwide have hypertension (HT), a major risk factor for cardiovascular disease. A significant proportion of HT patients remain unaware, untreated, and are uncontrolled, despite the availability of inexpensive and effective medications. Weaknesses in health systems are thought to be a key contributor to the inadequacies in HT care and control globally. We performed a systematic literature review to summarize the effects of national or regional health systems arrangements on HT care and control. Methods: An existing health systems framework was adapted to illustrate the impact of health systems components on HT outcomes (awareness, treatment prescription, treatment adherence and HT control) and guide the conduct of the systematic review. Studies analyzing effects of health systems arrangements at the regional or national level on HT outcomes were included, and Medline, Embase, and Global Health were searched for eligible studies. Two authors independently assessed papers for inclusion, extracted data, and assessed risk of bias using a simple proforma. Pooling of results was deemed inappropriate considering substantial variation in study designs. Results: Fifty studies met our eligibility criteria; 1 randomized controlled trial, 11 cohort, 3 case-control, 30 cross-sectional, 3 ecological, and 2 qualitative studies. Forty-one studies (82%) were set in high income countries, 35 of which were in the US. Most studies examined factors relating to the effect of either health systems financing (35) or health systems governance and delivery (16). Longitudinal studies, supported by some but not all cross-sectional studies, consistently reported a significant association between health insurance coverage in the US and improved HT awareness, medication adherence, and control (10 of 21 studies). There was also a consistent significant association, in both longitudinal and cross-sectional studies, between reduced co-payments for medical care and improved HT outcomes (10 of 11 studies). Although lacking longitudinal studies, we found a significant association in 12 of 14 US studies between having a routine place or physician for HT care, and HT outcomes. Conclusions: A largely consistent association between health insurance status, medication copayments, and routine availability of HT care with HT outcomes was found. Implications for policy are mainly applicable to the US setting, where our findings suggest that expanding insurance coverage and increasing access to routine care may improve HT outcomes. Additionally, minimization of co-payments for medication and care may improve HT outcomes in the US and to a limited extent in other non-US settings. Future research efforts should primarily focus on obtaining high quality longitudinal data and reducing the information gap in low and middle income countries, which bear three quarters of the global HT burden.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,024 | 0,099 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,009 | 0,008 |
| Bibliométrie | 0,020 | 0,023 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,005 | 0,005 |
| Science ouverte | 0,003 | 0,003 |
| Intégrité de la recherche | 0,003 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».