Delivering enhanced cardiovascular (Hypertension) disease care through private health facilities in Pakistan

BMC Cardiovascular Disorders

Haroon Jahangir Khan²  John Walley³  Maqsood Ahmed¹  Wajiha Javed¹  Muhammad Amir Khan¹ 

[1] Association for Social Development, Islamabad, Pakistan;Focal Person NCD, Directorate General of Health Services Punjab, Punjab, Pakistan;Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK

关键词: Urban health;    Public private mix;    Cardiovascular disease;   

Others  :  856856
DOI  :  10.1186/1471-2261-13-76

 received in 2012-09-18, accepted in 2013-09-19,  发布年份 2013

【 摘 要 】

Background

Cardiovascular diseases (CVDs) are one of the leading causes of death and disability in the world. Over 80% of CVD deaths take place in low-and middle-income countries. One-third of the population aged above 40 years suffers from Hypertension (HTN) and this is largely unreported as there is no registry for CVDs. No guidelines are available for use in health care facilities, especially private health facilities where practice among GPs varies considerably. We aim to conduct a Cluster Randomized Controlled trial delivering a quality HTN-CVD care package at strengthened private health facilities as compared to current practice at private health facilities.

Methods/Design

A pragmatic cluster randomized trial, with qualitative and economic studies, will be conducted in Sargodha district of Punjab, Pakistan, from January 2012 to December 2016. At least 912 hypertensives will be registered in the two arms, six clusters per arm. The proposed cluster randomized controlled trial will evaluate the effects of delivering quality HTN-CVD care, through enabled private health care facilities, to achieve better case registration, adherence and hypertension control also blood glucose and serum cholesterol control. The trial will be conducted through the doctors and paramedics at private health facilities. Main outcomes are mean difference in Systolic blood pressure among the two arms. Secondary outcomes are mean change in total serum cholesterol levels and mean change in glycaemic control achieved in the adult hypertensive patients. Individual and Cluster level analysis will be done according to intention-to-treat.

Discussion

Due to the high burden of disease where 1 in 3 individuals aged above 45 suffers from hypertension, topped with the fact that there is a dearth of a set of available, standardised guidelines for management, the disease is constantly on a hike in Pakistan. The government has made no effort to issue a set of guidelines adapted specifically for our population and this becomes more of a problem when managing CVD in urban population through private practitioners whose practices vary widely.If our set of context sensitive guidelines show an effectiveness in the proposed intervention districts it will be replicated in other such settings.

Trial registration

Current Controlled Trials ISRCTN34381594

【 授权许可】

   
2013 Khan et al.; licensee BioMed Central Ltd.

【 图 表 】

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