The Obstructive Lung Diseases Program: Integrated obstructive lung disease services within primary care in Pakistan

Objective: To assess the learning impact of e-curriculums on healthcare professionals (HCPs). The second objective was to report the screening, detection and clinical features of patients with obstructive lung diseases (OLD) through an integrated care program at The Indus Hospital & Health Network (IHHN), Karachi, Pakistan.

Methods: A retrospective, observational study was conducted in the Family Medicine outpatient department from January 2019 till July 2021. HCPs were trained on the diagnosis and management of OLD through e-learning. Patients were screened clinically for OLD and had spirometry performed if suspect. Baseline characteristics, patient-reported outcome measures (PROMs), spirometry and treatment modalities were collected. Univariate analysis was done on Excel and paired t-testing was performed on Stata 16.

Results: Online training on clinical aspects of OLD was completed by 33 HCPs, amongst whom 77.9% demonstrated improved post-test evaluations of 26.8% (p=0.000). Of 1896 patients screened, 60.8% were diagnosed as OLD. Asthmatics accounted for 66.5% (60.9% females, median age 39 years). In 84.5% of patients who completed PROMs, poor control of symptoms was reported. Inhaler technique was taught in 66.5%. Breathless patients, with a high modified Medical Research Council score (mMRC ≥ 2, n=234), were referred for pulmonary rehabilitation in 92% of cases. Tobacco cessation advice was delivered to 61.1% of all current users (n=229).

Conclusion: The OLD program uses capacity building, gold standard diagnostics and updated management strategies in primary care, allowing earlier diagnosis of suspected patients and implementation of evidence-based interventions, aiming to improve their morbidity and mortality.