Khan Muhammad Amir, Walley John D, Khan Nida, Khan Muhammad Ahmar, Ali Saima, King Rebecca, Khan Shaheer Ellahi, Sheikh Faisal Imtiaz, Manzoor Farooq, Khan Haroon Jehangir
Chief Coordinating Professional, Association for Social Development, Islamabad, Pakistan.
Professor of International Public Health, Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
BJGP Open. 2018 Nov 28;2(4):bjgpopen18X101613. doi: 10.3399/bjgpopen18X101613. eCollection 2018 Dec.
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.
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.
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.
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.
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.
在巴基斯坦，约18%的成年人患有高血压，而在所有高血压患者中，只有八分之一的患者血压得到控制。与许多其他中低收入国家一样，巴基斯坦正在考虑采用公私合作的方式在城市地区提供非传染性疾病护理。
进行本次过程评估，以了解医护人员和患者对综合护理干预的体验，并为可能的扩大规模前的调整提供依据。
这项混合方法研究是作为一项在26家私人诊所进行的高血压综合护理整群随机试验的一部分开展的。
通过分析1138名登记高血压患者的临床记录来评估护理实践。然后，通过对服务提供者和患者进行半结构化访谈，了解他们各自的护理体验。采用框架方法分析和解释定性数据。
由地区主导的客观选择和因地制宜的员工培训有助于诊所参与合作。约三分之一的高血压患者伴有糖尿病或肾脏损害。药物处方受到医护人员和患者多种非临床因素的影响。许多医生允许使用家庭疗法作为所开西药的补充。女性患者在改变生活方式方面面临更多挑战。该干预措施提高了患者对随访的依从性，但患者流失仍是一个挑战。
私人诊所的高血压综合护理干预是可行的，并在低收入国家城市环境中改善了诊断和治疗。作者建议继续开展实施研究，并在私人诊所进行明智的高血压护理推广。
