Delivering integrated hypertension care at private health facilities in urban Pakistan: a process evaluation

doi:10.3399/bjgpopen18X101613

. 2018 Nov 28;2(4):bjgpopen18X101613.

doi: 10.3399/bjgpopen18X101613. eCollection 2018 Dec.

Delivering integrated hypertension care at private health facilities in urban Pakistan: a process evaluation

Affiliations

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

PMID: 30723799
PMCID: PMC6348318
DOI: 10.3399/bjgpopen18X101613

Delivering integrated hypertension care at private health facilities in urban Pakistan: a process evaluation

Muhammad Amir Khan et al. BJGP Open. 2018.

. 2018 Nov 28;2(4):bjgpopen18X101613.

doi: 10.3399/bjgpopen18X101613. eCollection 2018 Dec.

Authors

Affiliations

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

PMID: 30723799
PMCID: PMC6348318
DOI: 10.3399/bjgpopen18X101613

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.

Keywords: Integrated care package; general practice; hypertension; mixed methods research; primary health care; private clinics.

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Conflict of interest statement

The authors declare that no competing interests exist.

Figures

**Figure 1.. Sampling for staff and patient interviews. SBP = systolic blood pressure.**

**Figure 2.. Patient attrition in intervention and control arms.**

See this image and copyright information in PMC

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References

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[1] Couser WG, Remuzzi G, Mendis S, et al. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int. 2011;80(12):1258–1270. doi: 10.1038/ki.2011.368. - DOI - PubMed

[2] Couser WG, Remuzzi G, Mendis S, et al. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int. 2011;80(12):1258–1270. doi: 10.1038/ki.2011.368. - DOI - PubMed

[3] Khan MA, Javed W, Ahmed M, et al. Delivering enhanced cardiovascular (Hypertension) disease care through private health facilities in Pakistan. BMC Cardiovasc Disord. 2013;13(1):7. doi: 10.1186/1471-2261-13-76. - DOI - PMC - PubMed

[4] Khan MA, Javed W, Ahmed M, et al. Delivering enhanced cardiovascular (Hypertension) disease care through private health facilities in Pakistan. BMC Cardiovasc Disord. 2013;13(1):7. doi: 10.1186/1471-2261-13-76. - DOI - PMC - PubMed

[5] Mohan S, Campbell NR. Hypertension management: time to shift gears and scale up national efforts. Hypertension. 2009;53(3):450–451. doi: 10.1161/HYPERTENSIONAHA.108.127076. - DOI - PubMed

[6] Mohan S, Campbell NR. Hypertension management: time to shift gears and scale up national efforts. Hypertension. 2009;53(3):450–451. doi: 10.1161/HYPERTENSIONAHA.108.127076. - DOI - PubMed

[7] Kearney PM, Whelton M, Reynolds K, et al. Worldwide prevalence of hypertension: a systematic review. J Hypertens. 2004;22(1):11–19. - PubMed

[8] Kearney PM, Whelton M, Reynolds K, et al. Worldwide prevalence of hypertension: a systematic review. J Hypertens. 2004;22(1):11–19. - PubMed

[9] World Health Organization . Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.

[10] World Health Organization . Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.

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Delivering integrated hypertension care at private health facilities in urban Pakistan: a process evaluation

Affiliations

Delivering integrated hypertension care at private health facilities in urban Pakistan: a process evaluation

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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