RT Journal Article SR Electronic T1 Effectiveness of delivering integrated COPD care at public healthcare facilities: a cluster randomised trial in Pakistan JF BJGP Open JO BJGP Open FD Royal College of General Practitioners SP bjgpopen18X101634 DO 10.3399/bjgpopen18X101634 VO 3 IS 1 A1 Khan, Muhammad Amir A1 Khan, Nida A1 Walley, John D A1 Khan, Muhammad Ahmar A1 Hicks, Joseph A1 Ahmed, Maqsood A1 Sheikh, Faisal Imtiaz A1 Ali, Muhammad A1 Manzoor, Farooq A1 Khan, Haroon Jehangir YR 2019 UL http://bjgpopen.org/content/3/1/bjgpopen18X101634.abstract AB Background In Pakistan chronic obstructive pulmonary disease (COPD) prevalence is 2.1% in adults aged >40 years. Despite being a health policy focus, integrated COPD care has remained neglected, with wide variation in practice.Aim To assess whether enhanced care at public health facilities resulted in better control of COPD, treatment adherence, and smoking cessation.Design & setting A two-arm cluster randomised controlled trial was undertaken in 30 public health facilities (23 primary and 7 secondary), across three districts of Punjab, between October 2014–December 2016. Both arms had enhanced diagnosis and patient recording processes. Intervention facilities also had clinical care guides; drugs for COPD; patient education flipcharts; associated staff training; and mobile phone follow-up.Method Facilities were randomised in a 1:1 ratio (sealed envelope independent lottery method), and 159 intervention and 154 control patients were recruited. The eligibility criteria were as follows: diagnosed with COPD, aged ≥18 years, and living in the catchment area. The primary outcome was change in BODE (Body mass index, airway Obstruction, Dyspnoea, Exercise capacity) index score from baseline to final follow-up visit. Staff and patients were not blinded.Results Six-month primary outcomes were available for 147/159 (92.5%) intervention and 141/154 (91.6%) control participants (all clusters). The primary outcome results cluster-level analysis were as follows: mean intervention outcome = -1.67 (95% confidence intervals [CI] = -2.18 to -1.16); mean control outcome = -0.66 (95% CI = -1.09 to -0.22); and covariate-adjusted mean intervention–control difference = -0.96 (95% CI = -1.49 to -0.44; P = 0.001).Conclusion The findings of this trial and a separate process evaluation study support the scaling of this integrated COPD care package at primary and secondary level public health facilities in Pakistan and similar settings.