How feasible is to deliver integrated COPD-Asthma care at primary and secondary level public healthcare facilities in Pakistan?

How feasible is to deliver integrated COPD-Asthma care at primary and secondary level public healthcare facilities in Pakistan?

This study, funded by Department for International Development (DFID), was done in partnership with; Provincial Program for Prevention and Control of Non-communicable Diseases & Mental Health; Directorate General of Health Services, Punjab; Nuffield Centre for International Health and Development, University of Leeds UK and World Health Organization (WHO).

Background: In Pakistan, the estimated prevalence of 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: This process evaluation was to understand how an integrated care package was experienced by care providers and patients, and inform modifications prior to scaling up.

Design and Settings: The mixed-method study was conducted as part of cluster randomized trials on integrated COPD and asthma care at 30 public health facilities.

Methods: The care practices were assessed by analysing the clinical records of 451 asthma and 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: Utilization of public health facilities for chronic lung conditions was low, mainly because of non-availability of inhalers. When diagnosed, about two-third of men and more than half of women 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 lesser and slower attrition in intervention arm). About half of the smoker males reported quitting smoking.

Conclusion: The integrated care of chronic lung conditions at public health facilities is feasible and leads to improved diagnosis and treatment in low-income country setting. We recommend scaling of the intervention with continued implementation research, especially on improving patient adherence to treatment.