Amir Khan Muhammad, Ahmar Khan Muhammad, Walley John D, Khan Nida, Imtiaz Sheikh Faisal, Ali Saima, Salahuddin Ehsan, King Rebecca, Ellahi Khan Shaheer, Manzoor Farooq, Jehangir Khan Haroon
Chief Coordinating Professional, Association for Social Development, Islamabad, Pakistan.
Research Coordinator, Association for Social Development, Islamabad, Pakistan.
BJGP Open. 2019 Feb 20;3(1):bjgpopen18X101632. doi: 10.3399/bjgpopen18X101632. eCollection 2019 Apr.
In Pakistan,the estimated prevalence of chronic obstructive pulmonary disease (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.
To understand how an integrated care package was experienced by care providers and patients, and to inform modifications prior to scaling up.
DESIGN & SETTING: The mixed-methods study was conducted as part of cluster randomised trials on integrated COPD and asthma care at 30 public health facilities.
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.
Utilisation of public health facilities for chronic lung conditions was low, mainly because of the non-availability of inhalers. When diagnosed, around two-thirds (69%) of male and more than half (55%) of female patients 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 attrition was lower and slower in the intervention arm). Around half of the male responders who smoked at baseline reported having quit smoking.
The integrated care of chronic lung conditions at public health facilities is feasible and leads to improved diagnosis and treatment in a low-income country setting. The authors recommend scaling of the intervention with continued implementation research, especially on improving patient adherence to treatment.
在巴基斯坦，慢性阻塞性肺疾病（COPD）和哮喘的估计患病率分别为2.1%和4.3%，现有护理在覆盖范围和质量方面都严重不足。建议采用综合方法在公共卫生机构提供慢性阻塞性肺疾病和哮喘护理。
了解护理提供者和患者对综合护理包的体验，并在扩大规模之前提供改进建议。
这项混合方法研究是在30个公共卫生机构进行的慢性阻塞性肺疾病和哮喘综合护理整群随机试验的一部分。
通过分析451例哮喘患者和313例慢性阻塞性肺疾病患者的临床记录来评估护理实践。通过对服务提供者和患者进行半结构化访谈来了解他们的护理体验。采用框架方法分析和解释定性数据。
公共卫生机构对慢性肺部疾病的利用率较低，主要原因是吸入器供应不足。确诊时，约三分之二（69%）的男性患者和半数以上（55%）的女性患者存在严重气道阻塞。干预组和对照组在吸入器处方实践上存在差异。患者不坚持随访仍然是主要的治疗挑战（尽管干预组的损耗率较低且较慢）。基线时吸烟的男性受访者中约有一半报告已戒烟。
在低收入国家背景下，公共卫生机构对慢性肺部疾病的综合护理是可行的，并能改善诊断和治疗。作者建议通过持续的实施研究扩大干预规模，特别是在提高患者对治疗的依从性方面。
