Abstract
BackgroundIn 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.AimTo understand how an integrated care package was experienced by care providers and patients, and to inform modifications prior to scaling up.Design & settingThe mixed-methods study was conducted as part of cluster randomised trials on integrated COPD and asthma care at 30 public health facilities.MethodThe 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.ResultsUtilisation 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.ConclusionThe 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.
Highlights
The global prevalences of chronic obstructive pulmonary disease (COPD) and asthma were estimated at 251 million and 235 million respectively, causing 3.17 million and 383 000 annual deaths.[1,2] Pakistan, a lower-middle income country with a population of around 200 million, is facing a high burden of chronic respiratory diseases, including COPD and asthma
The authors recommend scaling of the intervention with continued implementation research, especially on improving patient adherence to treatment. How this fits in Integrated care of chronic lung conditions is a known priority of non-communicable disease programmes, and evidence is needed for an informed programme scaling decision
This process evaluation study was conducted, as part of two intervention trials, to help the programme understand and refine the delivery and support of COPD and asthma care in public health facility settings
Summary
The global prevalences of COPD and asthma were estimated at 251 million and 235 million respectively, causing 3.17 million and 383 000 annual deaths.[1,2] Pakistan, a lower-middle income country with a population of around 200 million, is facing a high burden of chronic respiratory diseases, including COPD and asthma. The age-standardised mortality rate due to chronic respiratory diseases is estimated to be 138.2 per 100 000 in males and 41.3 per 100 000 among females in Pakistan. According to a national health survey, prevalence of smoking was 28.6% among males and 3.4% among females.[3] Clinical asthma prevalence has been estimated to be 4.3%,4 and as high as 10.7% among children aged 13–14 years.[5] High chronic respiratory disease prevalence poses a challenge to economic development, and to the quality of life of the population. Integration of clinical management at primary health care (PHC) level is the recommended approach to achieve universal coverage of non-communicable disease care.[6]. 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
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