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BJGP Open. 2019 Feb 20;3(1):bjgpopen18X101632. doi: 10.3399/bjgpopen18X101632. eCollection 2019 Apr.

Feasibility of delivering integrated COPD-asthma care at primary and secondary level public healthcare facilities in Pakistan: a process evaluation.

Author information

1
Chief Coordinating Professional, Association for Social Development, Islamabad, Pakistan.
2
Research Coordinator, Association for Social Development, Islamabad, Pakistan.
3
Professor of International Public Health, Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
4
Project Coordinator, Association for Social Development, Islamabad, Pakistan.
5
Lecturer, Nuffield Centre for International Health and Development, 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, Punjab, Pakistan.
8
Director, NCD & Mental Health, Directorate General of Health Services, Lahore, Pakistan.

Abstract

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.

KEYWORDS:

Asthma; COPD; Integrated care; mixed method research; public health facilities

Conflict of interest statement

The authors declare that no competing interests exist.

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