Strengthening prevention and management delivery services for chronic respiratory diseases in primary care

Background and Aim: Service delivery for chronic respiratory diseases (CRDs), namely asthma and COPD, are limited in Pakistan. We evaluate a novel chronic respiratory diseases’ prevention and management (CDPM) system, the Obstructive Lung Disease (OLD) program, in primary care. Rationale and intervention: Evaluation of medical records at the private, donation-based Indus Hospital and Health Network (IHHN) found CRDs amongst the commonest entered by general physicians (GPs). Discussions with relevant stakeholders confirmed need and willingness to develop interventions. The Lung Health team (pulmonologists, managers) established OLD, an integrated service providing primary level screening, diagnosis and provision of patient centered care for suspected CRDs. Strategy: Blended learning enabled a registered nurse to perform spirometry and provide patient education as a Lung Health nurse (LHN). International guidance on asthma and COPD was similarly delivered to GPs. A donor funded spirometer was installed within PCP clinics at The Indus Hospital, Karachi. Patient flow and data collection processes were optimized with staff. Scale-up proposals led to donated financial support for expansion. Sites were chosen collaboratively with PCP with capacity building from amongst local human resources. The first LHN became a master trainer and visited new sites for trouble shooting. Impact and challenges: The OLD program is operational at eight sites throughout Sindh (Karachi, Baba Island, Badin, Tharparkar) and Punjab (Muzaffargarh, Gurmani, Bhong, Lahore) with achievements described in Figure 1. Recruitment and retention of LHNs is an issue in Pakistan. Internet connectivity can hamper remote data monitoring. Integration was slower at PCP sites in public-private partnership with IHHN. Covid disproportionately affected OLD until safe spirometry practice was defined. Conclusion: Well-equipped CDPM programs within PCP are vital. Strong collaboration at all levels of stakeholders enabled successful implementation and local capacity building strengthened sustainability. Earlier disease recognition and patient empowerment are outcomes that will influence health and well-being.