This study demonstrated that the "basic package + personalized package (hypertension)" family doctor contracting service could improve the mean blood pressure (systolic and diastolic blood pressure), blood pressure control rate, cardiovascular disease risk level and self-management ability level in elderly patients with hypertension. And it was better than the "basic package" family doctor contract service in improving systolic blood pressure, blood pressure control rate, cardiovascular disease risk level and self-management ability level in elderly patients with hypertension.
Compared with the "basic package" service, the "basic package + personalized package (hypertension)" family doctor contract service proposed in this study is more significant in reducing the average blood pressure (systolic blood pressure) and improving the blood pressure control rate of elderly patients with hypertension, which suggests that the family doctor contract service which is added personalized scheme has a better effect on blood pressure control. A scholar pointed out that poor compliance is the main reason for the unsatisfactory treatment effect and repeated condition of patients with chronic diseases. The personalized scheme proposed in this study takes into account the individual differences of patients and combined with the wishes of patients, which is conducive to improving the compliance of patients' disease management, which may be the main reason for the improvement of patients' blood pressure control. At the same time, studies have shown that customized personalized intervention can enable patients to obtain more disease management information, which may also be another reason for the improvement of patients' blood pressure control. Sarah Melville et al.  also proposed that personalized medical plan is a new trend in the treatment of hypertension, especially in refractory hypertension. It is worth mentioning that one study have shown that home blood pressure monitoring can improve blood pressure control in patients with hypertension. The "basic package + personalized package (hypertension)" service scheme proposed in this study includes home blood pressure monitoring guidance, which may also be a reason for the improvement of blood pressure control in patients.
Studies have shown that there is a close and direct positive correlation between blood pressure level and cardiovascular disease risk, and the proportion of deaths from cardiovascular and cerebrovascular diseases in China has exceeded 40% of the total deaths. Therefore, the main goal of treating hypertension is to prevent the occurrence of cardiovascular disease. The contract service of "basic package + personalized package (hypertension)" family doctor proposed in this study can reduce the risk of cardiovascular disease in elderly patients with hypertension, which may be largely related to the improvement of blood pressure level. A scholar pointed out that the poor self-management ability of elderly patients with chronic diseases is a major reason why the situation of chronic disease treatment and management in China is not optimistic. Therefore, improving the self-management ability of elderly patients with chronic diseases has become a key link in chronic disease management in China. The "basic package + personalized package (hypertension)" family doctor contract service proposed by this study can improve the self-management ability of elderly patients with hypertension, which may be related to the following reasons: Firstly, the self-management ability assessment is included in the "basic package + personalized package (hypertension)" family doctor contract service, which is conducive to the family doctor team to grasp the overall situation of the patient's self-management ability, so as to take timely and targeted measures to improve the patient's self-management ability. Second, according to the "Knowledge-Attitude-Practice Theory Model", the premise of behavior change is to acquire knowledge and form belief, and the three are progressive at all levels. Only when knowledge is sublimated into belief can it promote behavior change in a positive attitude and way . The contract service mode of "basic package + personalized package" proposed by this study adopts the long-term contract management mode and regular follow-up to provide personalized health guidance for patients, which has the advantages of continuity, progression and systematicness; At the same time, experts from tertiary hospitals are invited to give lectures and provide health consulting services from time to time to provide patients with more professional and cutting-edge health knowledge and guidance. In this way, patients not only acquire disease management knowledge, but also continuously strengthen their awareness of self-management, so as to form beliefs and promote the establishment of good self-management behavior of patients. The main place of chronic disease management is still the family environment. Moreover, one study have shown that family members can affect patients' self-efficacy in disease management, and then affect patients' self-management ability. This study not only provides health guidance to patients, but also provides corresponding health guidance to family members. Family members mainly play the role of supervisor, reminder and motivator in disease management, while the main manager is still the patients themselves, which may also be a factor in the improvement of patients' self-management ability.
There are great differences between China's medical and health service system and that of developed countries. Firstly, there is a serious problem of uneven regional distribution of medical and health resources in China; Second, Chinese residents tend to go to high-level hospitals, and their trust in grass-roots hospitals is low; Third, the service ability and level of staff in grass-roots health service institutions in China are low; Finally, the medical insurance fund does not cover all family doctor signing projects. Therefore, the family doctor contract service model implemented in China is different from that in foreign countries. It is established based on China's national conditions and highlights Chinese characteristics. The characteristics of contract services of family doctors in China are mainly reflected in the following aspects: 1. The undertaker of contract services: Community health service center with the general practitioner team as the service provider; 2. Contract service content: While promoting basic services such as basic medical treatment, public health and health management, we should develop characteristic services such as traditional Chinese medical physiotherapy services and personalized package services for chronic diseases, so as to increase the attraction of grass-roots health service institutions. 3. Medical consortium form of contract services: China has formed four types of medical consortia: cross regional specialist alliance, urban medical group, telemedicine cooperation network and county medical community, which is conducive to improving the service capacity and level of grass-roots health service institutions and optimizing the allocation of medical and health resources, so as to improve residents' trust in grass-roots health service institutions; 4. Payment form of contract service fee: Take the form of government financial investment, medical insurance fund, new rural cooperative medical fund and individual payment, so as to provide economic guarantee for family doctor contract services. However, at present, the cost of personalized package service is still mainly borne by residents themselves. Therefore, in order to improve the signing rate of personalized package service, some changes need to be made from government finance and medical insurance fund in the future to subsidize the cost of personalized package service as much as possible.
The "basic package + personalized package" family doctor contract service model involved in this study is an innovative practice in the exploration of family doctor contract service model in China, which has the following advantages: 1. Different contract service packages meet the personalized needs of residents, enrich the connotation of family doctor contract service, and help to improve the attraction of signing service; 2. The whole population service mode is conducive to the promotion of primary prevention in chronic disease management, so as to reduce the prevalence of chronic diseases; 3. Health management takes the form of continuity, which helps to improve the functional status and quality of life of patients with chronic diseases; 4. Form a close regional medical community with tertiary hospitals to essentially promote the establishment of a hierarchical diagnosis and treatment system of "first diagnosis at the grass-roots level, two-way referral, separate treatment of acute and chronic diseases and upper and lower linkage" for patients with chronic diseases; 5. The family doctor team is composed of multidisciplinary personnel, which is conducive to improving the quality of life and treatment compliance of patients with chronic diseases.
This study also has some limitations. Firstly, this study is not a randomized controlled trial, and the choice of contract service type depends on the preference of patients. However, because the contract service of family doctors in China follows the principle of voluntary signing, it is difficult to carry out randomized controlled trials. Second, participants of our study were from one general Community Health Centre in Southwest China, which might limit the generalization of the results. Third, the services of the observation group and the control group were provided by two different family doctor teams, which may have a certain impact on the results due to the differences in the internal work mode, efficiency and personnel enthusiasm of the family doctor team, however, this study also took a series of measures such as unified training, process supervision and effect evaluation to reduce this impact. Finally, due to the limitation of research resources, this study did not carry out cost-benefit analysis, further research can be carried out in the future to evaluate the economic benefits of family doctor contract service model.