TY - JOUR
T1 - Effectiveness of delivering integrated COPD care at public healthcare facilities
T2 - A cluster randomised trial in Pakistan
AU - Khan, Muhammad Amir
AU - Khan, Nida
AU - Walley, John D.
AU - Khan, Muhammad Ahmar
AU - Hicks, Joseph
AU - Ahmed, Maqsood
AU - Sheikh, Faisal Imtiaz
AU - Ali, Muhammad
AU - Manzoor, Farooq
AU - Khan, Haroon Jehangir
N1 - Publisher Copyright:
© 2019, The Authors.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - 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.
AB - 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.
KW - COPD
KW - General practice
KW - Integrated care package
KW - Pakistan
KW - Primary care
KW - Public health facilities
UR - https://www.scopus.com/pages/publications/85081707214
U2 - 10.3399/bjgpopen18X101634
DO - 10.3399/bjgpopen18X101634
M3 - Article
AN - SCOPUS:85081707214
SN - 1849-5435
VL - 3
JO - BJGP Open
JF - BJGP Open
IS - 1
ER -
