The Association Between Panel Size and Health Outcomes of Patients with Hypertension in Urban China: a Population-Based Retrospective Cohort Study

Abstract

There is a paucity of evidence regarding the association between family physicians’ panel size and health outcomes of patients with hypertension in China. To examine the association between family physicians’ panel size and health outcomes of patients with hypertension in urban China. This retrospective cohort study during 1 contract year from July 1, 2018, to June 31, 2019, was set in four community health centers (CHCs) in Xiamen City, China. A total of 18,119 adult patients (18+) diagnosed with hypertension and their 61 family physicians were included. Family physicians’ panel size was measured by the number of registered patients in the preceding 6 months. The outcome measures included blood pressure (BP) control rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) measured at each follow-up visit. Every additional 100 patients to the panel size were associated with an average of 17% increase in BP control rate (95% confidence interval [CI] = 1.15 to 1.19), and decrease in SBP (− 0.3 mmHg, 95% CI: − 0.38 to − 0.30), DBP (− 0.4 mmHg, 95% CI: − 0.39 to − 0.34), and MAP (− 0.4 mmHg, 95% CI: − 0.38 to − 0.33). After entering the quadratic term of panel size in the model, the panel size was negatively associated with BP control rate and positively associated with SBP, DBP, and MAP, while for the quadratic term, the odds ratio for BP control rate was positive and the coefficients for SBP, DBP, and MAP were negative. A U-shape association was found between panel size and health outcomes of patients with hypertension, and the turning point was about 600 patients. The panel size of family physicians was curvilinearly associated with health outcomes of patients with hypertension in urban China.