RT Journal Article
SR Electronic
T1 Feasibility of delivering integrated COPD-asthma care at primary and secondary level public healthcare facilities in Pakistan: a process evaluation
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP bjgpopen18X101632
DO 10.3399/bjgpopen18X101632
VO 3
IS 1
A1 Amir Khan, Muhammad
A1 Ahmar Khan, Muhammad
A1 Walley, John D
A1 Khan, Nida
A1 Imtiaz Sheikh, Faisal
A1 Ali, Saima
A1 Salahuddin, Ehsan
A1 King, Rebecca
A1 Ellahi Khan, Shaheer
A1 Manzoor, Farooq
A1 Jehangir Khan, Haroon
YR 2019
UL http://bjgpopen.org/content/3/1/bjgpopen18X101632.abstract
AB 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.