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. 2019 Mar 20;3(1):bjgpopen18X101634.
doi: 10.3399/bjgpopen18X101634. eCollection 2019 Apr.

Effectiveness of delivering integrated COPD care at public healthcare facilities: a cluster randomised trial in Pakistan

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

Effectiveness of delivering integrated COPD care at public healthcare facilities: a cluster randomised trial in Pakistan

Muhammad Amir Khan et al. BJGP Open. .

Abstract

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.

Keywords: COPD; Pakistan; general practice; integrated care package; primary care; public health facilities.

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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

References

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