Enhancing primary health care for chronic lung disease management assisted by frontline health care workers in low resource settings in India: feasibility study

Clinical Research Results Abstract Introduction: Chronic respiratory diseases (CRDs) are the second most common cause of death and fourth most common cause of morbidity in India.1 This burden of disease arises not only from known risk factors like indoor/outdoor air pollution, occupational exposures and smoking, but also because of low awareness among the people, under-diagnosis and poor access to care.2,3 Frontline health care workers’ (HCWs) services could help raise community awareness on risk reduction and appropriate treatment options, offer screening services at peripheral health centers, and improve patient pathways. Methods: The feasibility of HCW-delivered interventions was studied in two village clusters with 50 participants in each cluster. The intervention package included training HCWs to screen patients for CRD, refer for confirmation of diagnosis to community health centre with physician assessment, spirometry and CXR, and education of participants, family members, community members using multiple tools (Fig.1). Also there was demonstration of inhaler use and respiratory exercise at the peripheral center and patient follow-up through home visits. A pre-post survey assessed changes in knowledge, attitudes and behaviour at the end of 1 year of intervention. Further, a 3-monthly physician assessment, 6-monthly spirometry and St. George Respiratory Questionnaire administered by HCWs assessed disease progress. Results: Pre-post assessment showed that it is feasible to enhance primary health care for CRD management using the services of trained HCWs (Table 1). Of the 140 patients who were identified to have symptoms of CRD, 104 had a confirmed diagnosis. Drop-out rate was only 7%. Challenges included maintaining HCW motivation – to counter this, feedback was given to HCWs on patient outcomes at training and review meetings.Discussion: Using primary health care approaches with the assistance of HCWs to function as primary screeners, peer educators and patient navigators is an effective strategy to improve disease outcomes in a resource constrained health system Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest Declaration of interestWe have no potential conflicts of interest to report References and Clinical Trial Registry Information ReferencesIndia State-Level Disease Burden Initiative CRD Collaborators.The burden of chronic respiratory diseases and their heterogeneity across the states of India: the Global Burden of Disease Study 1990–2016. The Lancet Global Health Vol 6(12): E1363-E1374, Dec 01, 2018.Salvi S, Agrawal A. India needs a national COPD prevention and control programme. J Assoc Physicians India 2012;60 (Suppl.):5-7McKay AJ, Mahesh PA, Fordham JZ, et al. Prevalence of COPD in India: A systematic review. Prim Care Respir J. 2012;21:313–21; Vijayan V. K. (2013). Chronic obstructive pulmonary disease. Indian J.Med.Res.137, 251–269