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Accessibility of Antihypertensive Medications in China
Study Questions:
How accessible are antihypertensive medications in Chinese primary health care?
Methods:
Data from a nationwide cross-sectional survey were used for the present analysis. The China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project Primary health care survey was conducted between November 2016 and May 2017, to assess the availability, cost, and prescription patterns of 62 antihypertensive medications at primary healthcare sites across 31 Chinese provinces. A total of 203 community health centers, 401 community health stations, 284 township health centers, and 2,474 village clinics were included in this assessment of variation in availability, cost, and prescription by economic region and type of site. Data on the use of high-value medications, defined as guideline-recommended and low-cost, were also assessed. Medication cost was examined in association with variation in availability and prescription patterns.
Results:
A total of 3,362 primary healthcare sites and approximately 1 million adults (613,638 people at 2,758 rural sites and 478,393 people at 604 urban sites) were included in this analysis. Of the 3,362 sites, 8.1% (95% confidence interval, 7.2-9.1) stocked no antihypertensive medications and 33.8% (32.2-35.4) stocked all four classes that were routinely used. Village clinics and sites in the western region of China had the lowest availability. Only 32.7% (32.2-33.3) of all sites stocked high-value medications, and few high-value medications were prescribed (11.2% [10.9-11.6] of all prescription records). High-cost medications were more likely to be prescribed than low-cost alternatives.
Conclusions:
The investigators concluded that China has marked deficiencies in the availability, cost, and prescription of antihypertensive medications. High-value medications are not preferentially used. Future efforts to reduce the burden of hypertension, particularly through the work of primary healthcare providers, will need to improve access to, and use of, antihypertensive medications, paying particular attention to those with high value.
Perspective:
Studies such as the one presented in this paper highlight the value of assessing prescribing patterns on a national level. These data will allow for the improvement of access to antihypertensive medications where they are needed the most.
Keywords: Antihypertensive Agents, China, Community Health Centers, Drug Costs, Health Care Quality, Access, and Evaluation, Hypertension, Prescription Drugs, Primary Health Care, Primary Prevention
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