The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure , but low for diastolic blood pressure .
INTERPRETATION Task-sharing interventions are effective in reducing blood pressure .
BACKGROUND Task sharing for the management of hypertension could be useful for understaffed and re source -poor health systems .
We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries .
The effect of community-based health management on the health of the elderly: a randomized controlled trial from China
Background An aging population poses significant challenges to health care in China .  Health management has been implemented to reduce the costs of care , raise health service utilization , increase health knowledge and improve quality of life . Several studies have tried to verify the effectiveness of health management in achieving these goals worldwide . However , there have been insufficient r and omized control trials ( RCTs ) to draw reliable conclusions . The few small-scale studies conducted in China include mostly the general population rather than the elderly . Our study is design ed to evaluate the impact of community-based health management on the health of the elderly through an RCT in Nanjing , China . Methods Two thous and four hundred participants , aged 60 or older and who gave informed consent , were r and omly allocated 1:1 into management and control groups , the r and omization schedule was concealed from community health service center staff until allocation . Community-based health management was applied in the former while the latter was only given usual care . After 18 months , three categories of variables ( subjective grading health indices , objective health indices and health service utilization ) were measured based on a question naire , clinical monitoring and diagnostic measurements . Differences between the two groups were assessed before and after the intervention and analyzed with t-test , χ2-test , and multiple regression analysis . Results Compared with the control group , the management group demonstrated improvement on the following variables ( P<0.01 ) : health knowledge score , self-evaluated psychological conditions , overall self-evaluated health conditions , diet score , physical activity duration per week , regular blood pressure monitoring , waist-to-hip ratio , systolic blood pressure and fasting blood sugar . The number of outpatient clinic visits did not differ significantly ( P=0.60 ) between the two groups before intervention , while after intervention it was smaller in the management group than in the control group ( P<0.01 ) . However , the number of hospital admissions in the preceding 6 months was not different between the two groups even after intervention ( P=0.36 ) . Multiple regression analysis showed that gender , age , education level , chronic disease status and self-evaluated psychological conditions were important factors affecting health knowledge score , BMI , and waist-to-hip ratio .  Conclusion Community-based health management improved both subjective grading health indices , objective health indices and decreased the number of outpatient clinic visits , demonstrating effectiveness in improving elderly health . Trial registration
The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure , but low for diastolic blood pressure .
INTERPRETATION Task-sharing interventions are effective in reducing blood pressure .
BACKGROUND Task sharing for the management of hypertension could be useful for understaffed and re source -poor health systems .
We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries .