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. 2019 Jan 23;3(1):bjgpopen18X101617.
doi: 10.3399/bjgpopen18X101617. eCollection 2019 Apr.

Enhanced hypertension care through private clinics in Pakistan: a cluster randomised trial

Muhammad Amir Khan  1 , Nida Khan  2 , John D Walley  3 , Shaheer Ellahi Khan  4 , Joseph Hicks  5 , Faisal Imtiaz Sheikh  6 , Muhammad Ahmar Khan  6 , Muhammad Ali  7 , Maqsood Ahmed  8 , Haroon Jehangir Khan  9 , Rony Zachariah  10
Affiliations

Enhanced hypertension care through private clinics in Pakistan: a cluster randomised trial

Muhammad Amir Khan et al. BJGP Open. .

Abstract

Background: Hypertension in Pakistan affects 33% of people aged ≥45 years, and in urban areas around 70% of basic health care occurs in private facilities.

Aim: To assess whether enhanced care at urban private clinics resulted in better control of hypertension, cardiovascular disease (CVD) risk factors, and treatment adherence.

Design & setting: A two-arm cluster randomised controlled trial was conducted at 26 private clinics (in three districts of Punjab) between January 2015-September 2016. Both arms had enhanced screening and diagnosis of hypertension and related conditions, and patient recording processes. Intervention facilities also had a clinical care guide, additional drugs for hypertension, a patient lifestyle education flipchart, associated training, and mobile phone follow-up.

Method: Clinics were randomised in a 1:1 ratio (sealed envelope lottery method). A total of 574 intervention and 564 control patients in 13 clusters in each arm were recruited (male and female, aged ≥25 years, systolic blood pressure [SBP] >140 mmHg, and/or diastolic blood pressure [DBP] >90 mmHg). The primary outcome was change in SBP from baseline to 9-month follow-up.Staff and patients were not blinded, but outcome assessors were blinded.

Results: Nine-month primary outcomes were available for 522/574 (90.9%) intervention and 484/564 (85.8%) control participants (all clusters). The unadjusted cluster-level analysis results were as follows: mean intervention outcome was -25.2 mmHg (95% confidence intervals [CI] = -29.9 to-20.6); mean control outcome was -9.4 mmHg (95% CI = 21.2 to 2.2); and mean control-intervention difference was 15.8 (95% CI = 3.6 to 28.0; P = 0.01).

Conclusion: The findings and separate process evaluation support the scaling of an integrated CVD-hypertension care intervention in urban private clinics in areas lacking public primary care in Pakistan.

Keywords: Cluster randomised controlled trial; contextualised care package; general practice; hypertension; primary care; primary private clinics.

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Conflict of interest statement

The authors declare that no competing interests exist.

Figures

Figure 1.
Figure 1.. CONSORT trial flow chart
See this image and copyright information in PMC

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