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Research

Feasibility of delivering integrated COPD-asthma care at primary and secondary level public healthcare facilities in Pakistan: a process evaluation

Muhammad Amir Khan, Muhammad Ahmar Khan, John D Walley, Nida Khan, Faisal Imtiaz Sheikh, Saima Ali, Ehsan Salahuddin, Rebecca King, Shaheer Ellahi Khan, Farooq Manzoor and Haroon Jehangir Khan
BJGP Open 2019; 3 (1): bjgpopen18X101632. DOI: https://doi.org/10.3399/bjgpopen18X101632
Muhammad Amir Khan
1Chief Coordinating Professional, Association for Social Development, , Pakistan
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Muhammad Ahmar Khan
2Research Coordinator, Association for Social Development, , Pakistan
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  • For correspondence: ahmarkhan@asd.com.pk
John D Walley
3Professor of International Public Health, Nuffield Centre for International Health and Development, University of Leeds, , UK
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Nida Khan
4Project Coordinator, Association for Social Development, , Pakistan
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Faisal Imtiaz Sheikh
5Research Coordinator, Association for Social Development, , Pakistan
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Saima Ali
6Research Coordinator, Association for Social Development, , Pakistan
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Ehsan Salahuddin
7Research Coordinator, Association for Social Development, , Pakistan
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Rebecca King
8Lecturer, Nuffield Centre for International Health and Development, University of Leeds, , UK
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Shaheer Ellahi Khan
10Assistant Professor, Humanities and Social Sciences Department, Bahria University, , Pakistan
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Farooq Manzoor
9Provincial Manager, Non-Communicable Disease Control Program, , Pakistan
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Haroon Jehangir Khan
11Director, NCD & Mental Health, Directorate General of Health Services, , Pakistan
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Abstract

Background In Pakistan,the estimated prevalence of chronic obstructive pulmonary disease (COPD) and asthma are 2.1% and 4.3% respectively, and existing care is grossly lacking both in coverage and quality. An integrated approach is recommended for delivering COPD and asthma care at public health facilities.

Aim To understand how an integrated care package was experienced by care providers and patients, and to inform modifications prior to scaling up.

Design & setting The mixed-methods study was conducted as part of cluster randomised trials on integrated COPD and asthma care at 30 public health facilities.

Method The care practices were assessed by analysing the clinical records of n = 451 asthma and n = 313 COPD patients. Semi-structured interviews with service providers and patients were used to understand their care experiences. A framework approach was applied to analyse and interpret qualitative data.

Results Utilisation of public health facilities for chronic lung conditions was low, mainly because of the non-availability of inhalers. When diagnosed, around two-thirds (69%) of male and more than half (55%) of female patients had severe airway obstruction. The practice of prescribing inhalers differed between intervention and control arms. Patient non-adherence to follow-up visits remained a major treatment challenge (though attrition was lower and slower in the intervention arm). Around half of the male responders who smoked at baseline reported having quit smoking.

Conclusion The integrated care of chronic lung conditions at public health facilities is feasible and leads to improved diagnosis and treatment in a low-income country setting. The authors recommend scaling of the intervention with continued implementation research, especially on improving patient adherence to treatment.

  • Integrated care
  • public health facilities
  • mixed method research
  • Asthma
  • COPD
  • Received May 3, 2018.
  • Accepted August 20, 2018.
  • Copyright © The Authors 2019

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Feasibility of delivering integrated COPD-asthma care at primary and secondary level public healthcare facilities in Pakistan: a process evaluation
Muhammad Amir Khan, Muhammad Ahmar Khan, John D Walley, Nida Khan, Faisal Imtiaz Sheikh, Saima Ali, Ehsan Salahuddin, Rebecca King, Shaheer Ellahi Khan, Farooq Manzoor, Haroon Jehangir Khan
BJGP Open 2019; 3 (1): bjgpopen18X101632. DOI: 10.3399/bjgpopen18X101632

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Feasibility of delivering integrated COPD-asthma care at primary and secondary level public healthcare facilities in Pakistan: a process evaluation
Muhammad Amir Khan, Muhammad Ahmar Khan, John D Walley, Nida Khan, Faisal Imtiaz Sheikh, Saima Ali, Ehsan Salahuddin, Rebecca King, Shaheer Ellahi Khan, Farooq Manzoor, Haroon Jehangir Khan
BJGP Open 2019; 3 (1): bjgpopen18X101632. DOI: 10.3399/bjgpopen18X101632
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Keywords

  • Integrated care
  • public health facilities
  • mixed method research
  • asthma
  • COPD

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