TY - JOUR T1 - Enhanced hypertension care through private clinics in Pakistan: a cluster randomised trial JF - BJGP Open JO - BJGP Open DO - 10.3399/bjgpopen18X101617 VL - 3 IS - 1 SP - bjgpopen18X101617 AU - Muhammad Amir Khan AU - Nida Khan AU - John D Walley AU - Shaheer Ellahi Khan AU - Joseph Hicks AU - Faisal Imtiaz Sheikh AU - Muhammad Ahmar Khan AU - Muhammad Ali AU - Maqsood Ahmed AU - Haroon Jehangir Khan AU - Rony Zachariah Y1 - 2019/04/01 UR - http://bjgpopen.org/content/3/1/bjgpopen18X101617.abstract N2 - Background Hypertension in Pakistan affects 33% of people aged ≥45 years, and in urban areas around 70% of basic health care occurs in private facilities.Aim To assess whether enhanced care at urban private clinics resulted in better control of hypertension, cardiovascular disease (CVD) risk factors, and treatment adherence.Design & setting A two-arm cluster randomised controlled trial was conducted at 26 private clinics (in three districts of Punjab) between January 2015–September 2016. Both arms had enhanced screening and diagnosis of hypertension and related conditions, and patient recording processes. Intervention facilities also had a clinical care guide, additional drugs for hypertension, a patient lifestyle education flipchart, associated training, and mobile phone follow-up.Method Clinics were randomised in a 1:1 ratio (sealed envelope lottery method). A total of 574 intervention and 564 control patients in 13 clusters in each arm were recruited (male and female, aged ≥25 years, systolic blood pressure [SBP] >140 mmHg, and/or diastolic blood pressure [DBP] >90 mmHg). The primary outcome was change in SBP from baseline to 9-month follow-up.Staff and patients were not blinded, but outcome assessors were blinded.Results Nine-month primary outcomes were available for 522/574 (90.9%) intervention and 484/564 (85.8%) control participants (all clusters). The unadjusted cluster-level analysis results were as follows: mean intervention outcome was -25.2 mmHg (95% confidence intervals [CI] = -29.9 to-20.6); mean control outcome was -9.4 mmHg (95% CI = 21.2 to 2.2); and mean control–intervention difference was 15.8 (95% CI = 3.6 to 28.0; P = 0.01).Conclusion The findings and separate process evaluation support the scaling of an integrated CVD–hypertension care intervention in urban private clinics in areas lacking public primary care in Pakistan. ER -