Khan, MA, Walley, JD orcid.org/0000-0001-7290-0989, Khan, N et al. (7 more authors) (2018) Delivering integrated hypertension care at private health facilities in urban Pakistan: a process evaluation. BJGP Open, 2 (4). bjgpopen18. ISSN 2398-3795
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Authors 2018. This is an open access article under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) (https://creativecommons.org/licenses/by/4.0/) |
Keywords: | Integrated care package; private clinics; mixed methods research; hypertension; primary health 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: | 10 Feb 2020 11:17 |
Last Modified: | 10 Feb 2020 11:17 |
Status: | Published |
Publisher: | Royal College of General Practitioners |
Identification Number: | 10.3399/bjgpopen18X101613 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:156770 |