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BJGP Open. 2018 Nov 28;2(4):bjgpopen18X101613. doi: 10.3399/bjgpopen18X101613. eCollection 2018 Dec.

Delivering integrated hypertension care at private health facilities in urban Pakistan: a process evaluation.

Author information

1
Chief Coordinating Professional, Association for Social Development, Islamabad, Pakistan.
2
Professor of International Public Health, Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
3
Project Coordinator, Association for Social Development, Islamabad, Pakistan.
4
Research Coordinator, Association for Social Development, Islamabad, Pakistan.
5
Lecturer, Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
6
Assistant Professor, Humanities and Social Sciences Department, Bahria University, Islamabad, Pakistan.
7
Provincial Manager, Non-Communicable Disease Control Program, Lahore, Pakistan.
8
Director, NCD & Mental Health, Directorate General of Health Services, Punjab, Pakistan.

Abstract

Background:

In Pakistan about 18% of all adults are affected by hypertension, and only one in eight of the prevalent cases have their hypertension controlled. As in many other low-middle income countries, a public-private partnership approach is being considered for delivering non-communicable disease care in urban areas.

Aim:

This process evaluation was undertaken to understand how an integrated care intervention was experienced by the care providers and patients, and to inform modifications before possible scaling.

Design & setting:

The mixed-methods study was conducted as part of a cluster randomised trial on integrated hypertension care at 26 private clinics.

Method:

The care practices were assessed by analysing the clinical records of 1138 registered patients with hypertension. Then semi-structured interviews with service providers and patients were used to understand their respective care experiences. A framework approach was applied to analyse and interpret the qualitative data.

Results:

District-led objective selection and context-sensitive staff training helped to get the clinics engaged in partnership working. About one-third of patients with hypertension had associated diabetes or renal compromise. The prescription of drugs is influenced by multiple non-clinical considerations of providers and patients. Many doctors allowed the use of home-based remedies as supplements to the prescribed allopathic drugs. Female patients faced more challenges in managing lifestyle changes. The intervention improved adherence to follow-up visits, but patient attrition remained a challenge.

Conclusion:

The integrated hypertension care intervention at private clinics is feasible, and leads to improved diagnosis and treatment in low-income country urban setting. The authors recommend continued implementation research and informed scaling of hypertension care at private clinics.

KEYWORDS:

Integrated care package; general practice; hypertension; mixed methods research; primary health care; private clinics

Conflict of interest statement

The authors declare that no competing interests exist.

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