Khan, MA, Khan, N, Walley, JD orcid.org/0000-0001-7290-0989 et al. (7 more authors) (2019) Effectiveness of delivering integrated COPD care at public healthcare facilities: a cluster randomised trial in Pakistan. BJGP Open, 3 (1). bjgpopen18. ISSN 2398-3795
Abstract
Background In Pakistan chronic obstructive pulmonary disease (COPD) prevalence is 2.1% in adults aged >40 years. Despite being a health policy focus, integrated COPD care has remained neglected, with wide variation in practice.
Aim To assess whether enhanced care at public health facilities resulted in better control of COPD, treatment adherence, and smoking cessation.
Design & setting A two-arm cluster randomised controlled trial was undertaken in 30 public health facilities (23 primary and 7 secondary), across three districts of Punjab, between October 2014–December 2016. Both arms had enhanced diagnosis and patient recording processes. Intervention facilities also had clinical care guides; drugs for COPD; patient education flipcharts; associated staff training; and mobile phone follow-up.
Method Facilities were randomised in a 1:1 ratio (sealed envelope independent lottery method), and 159 intervention and 154 control patients were recruited. The eligibility criteria were as follows: diagnosed with COPD, aged ≥18 years, and living in the catchment area. The primary outcome was change in BODE (Body mass index, airway Obstruction, Dyspnoea, Exercise capacity) index score from baseline to final follow-up visit. Staff and patients were not blinded.
Results Six-month primary outcomes were available for 147/159 (92.5%) intervention and 141/154 (91.6%) control participants (all clusters). The primary outcome results cluster-level analysis were as follows: mean intervention outcome = -1.67 (95% confidence intervals [CI] = -2.18 to -1.16); mean control outcome = -0.66 (95% CI = -1.09 to -0.22); and covariate-adjusted mean intervention–control difference = -0.96 (95% CI = -1.49 to -0.44; P = 0.001).
Conclusion The findings of this trial and a separate process evaluation study support the scaling of this integrated COPD care package at primary and secondary level public health facilities in Pakistan and similar settings.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | Copyright © 2019, The Authors; This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/) |
Keywords: | Pakistan; public health facilities; COPD; Integrated care package; primary care; general practice |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Nuffield Centre for International Health and Development (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 14 May 2020 12:18 |
Last Modified: | 14 May 2020 12:18 |
Status: | Published |
Publisher: | Royal College of General Practitioners |
Identification Number: | 10.3399/bjgpopen18x101634 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:160625 |