Enhanced hypertension care through private clinics in Pakistan: a cluster randomised trial
| Autor: | Joseph P. Hicks, John Walley, Rony Zachariah, Shaheer Ellahi Khan, Haroon Jehangir Khan, Muhammad Ahmar Khan, Faisal Imtiaz Sheikh, Muhammad Ali, Maqsood Ahmed, Muhammad Amir Khan, Nida Khan |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
hypertension 030231 tropical medicine Disease Primary care 03 medical and health sciences primary care 0302 clinical medicine Intervention (counseling) Health care Medicine 030212 general & internal medicine Cluster randomised controlled trial general practice lcsh:R5-920 business.industry Research Confidence interval Blood pressure Emergency medicine contextualised care package Process evaluation Family Practice business primary private clinics lcsh:Medicine (General) |
| Zdroj: | BJGP Open, Vol 3, Iss 1 (2019) BJGP Open |
| ISSN: | 2398-3795 |
| Popis: | BackgroundHypertension in Pakistan affects 33% of people aged ≥45 years, and in urban areas around 70% of basic health care occurs in private facilities.AimTo assess whether enhanced care at urban private clinics resulted in better control of hypertension, cardiovascular disease (CVD) risk factors, and treatment adherence.Design & settingA 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.MethodClinics 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.ResultsNine-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).ConclusionThe 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. |
| Databáze: | OpenAIRE |
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