Comparison of the management and control of hypertension by public and private primary care providers in Shenzhen, China

BACKGROUND: The Chinese government has designated primary care as the cornerstone for addressing the public health challenges posed by hypertension. In urban China, primary care is usually delivered by either publicly- or privately-owned community health centers (CHCs), and whether there CHCs can achieve the same population health objectives remains unknown. This study aimed to compare management and control of hypertension by public versus private primary care providers. METHODS: A face-to-face, cross-sectional patient survey was performed on-site at 12 CHCs in Shenzhen, China (3 privately owned and 9 publicly owned). A total of 1046 hypertensive patients were selected via systematic sampling methods and completed the survey. Information regarding primary care management, anti-hypertensive drug treatment and compliance, and blood pressure was recorded. RESULTS: Compared with hypertensive patients enrolled from private CHCs, those from public CHCs were more likely to be managed by CHCs (84.6% vs. 61.6%; odds ratio [OR] = 2.594, 95% confidence interval [CI]: 1.730–3.891), to take anti-hypertensive drugs (87.5% vs. 66.8%; OR = 3.193, 95%CI: 1.995–5.110), and to adhere to physicians' advice (91.5% vs. 82.5%; OR = 1.930, 95%CI: 1.0002–3.717). However, hypertension control rates did not differ significantly between public and private CHCs (48.3% vs. 37.6%; P > 0.01, tested by multiple logistic regression models). CONCLUSIONS: Public CHCs showed better performance for the management of hypertensive patients compared with private CHCs, although there is room for improvements for both types of CHCs. Initiation of interventions to motivate primary care providers in both public and private CHCs to comply with hypertension management guidelines is recommended.