Enhancing chronic respiratory disease care through upskilling healthcare providers of the government health system in a rural district in India: a pre-post educational intervention trial

Research Question: Can the quality of CRD care be improved in primary healthcare through capacity building and skills training? Background: Chronic respiratory diseases (CRDs) are a global health problem with low- and middle-income countries (LMICs) contributing about 90% of global DALYs and deaths, and India alone contributing to approximately one-third of cases, suggesting a high CRD burden and unmet health need. CRD care being largely limited to tertiary care and inadequately equipped primary healthcare with diagnosis being clinical (without spirometry) and oral medications being used for treatment (with scarce use of inhalers) contribute to the unmet health needs. Besides lack of a definitive policy on CRD, low public awareness, limited access to and scarce diagnostic capability in primary healthcare facilities and want of protocol-based treatment using current evidence contribute to the disease burden in our country. Capacity building, training and skill development can lead to better access and availability and improve quality of respiratory care through better practice. Methods: The study will be conducted as a one group pre-post-test, quasi-experimental study design. A needs assessment will be conducted in government primary health centres using WHO Harmonised Health Facility Assessment questionnaire, review of reports and registers to assess the gaps in facility and resources, knowledge, attitude and practice (KAP) of the providers and exit interviews among patients. Data for the facility assessment form will be collected through interviews with the senior nursing leadership / doctors and direct observation. Spirometer will be provided, tailored training sessions for doctors, community health workers and therapists on CRDs will orient them to evidence-based diagnosis and management of CRDs including health education, follow-up and referral. Patients’ experience of CRD care will be assessed by using adapted British Lung Foundation COPD Patient Passport Responses and compliance to treatment using Test of Adherence to Inhalers.