Practices and perceptions of primary care physicians in rural India for diagnosis and management of asthma and COPD: a mixed methods study

Background: At the national level, chronic respiratory diseases (CRD), especially asthma and COPD, are common public health problems. For individuals, chronic respiratory symptoms can be disabling, contribute to significant hospitalization and poor quality of life. Weak primary health care systems in resource-poor countries are often unable to diagnose the disease and lack of resources for effective management. Community Health Workers can help to detect CRD and refer people for diagnosis, but there is a need to understand the perceptions and practices of primary care physicians (“GPs”) who provide the majority of healthcare for populations in rural India. Research Question: Amongst public and private GPs in rural IndiaWhat are the perceptions about risk factors, and clinical features of asthma and COPD?How are the diagnoses of asthma and COPD made?What are the facilitators/barriers to accurate diagnosis and quality care? Methodology: In a mixed-method study, we will give a study questionnaire about managing patients with asthma and COPD, to all GPs in the Junnar block, Pune district (n»450). The data will be used to inform the purposive sampling of GPs with differing views and experiences for in-depth interviews. The interview topic guide will include vignettes of patients with asthma or COPD in order to elicit perceptions of these conditions; GPs current practice for establishing a diagnosis, and managing asthma and COPD; and explore perceived barriers and facilitators to care provision. Interviews will be transcribed, coded and analyzed thematically. Questions to discuss: What criteria to be used for the selection of GPs for in-depth interviews?What barriers and facilitators should I be asking about?We plan to use vignettes; what sort of clinical case would be most revealing about clinical management? Declaration of Interest Funding: DA is supported by a Fellowship from NIHR Global Health Research Unit on Respiratory Health (RESPIRE) 16/136/109 References and Clinical Trial Registry Information