Enhanced diabetes and cardiovascular disease management through primary health care in Pakistan

This study aims to enhance the access and quality of care for Type 2 diabetes and associated hypertension and hyper-cholesterol conditions, through enabled primary health care in Pakistan.
Pakistan ranks 7th in the top 10 countries globally for the highest number of people with diabetes. According to the Diabetic Association of Pakistan, 10% of people over the age of 25 have Type 2 diabetes. It is estimated that one third of people with Type 2 diabetes also have associated conditions of hypertension or raised cholesterol.
The Pakistan Integrated National Plan for Non-Communicable Disease emphasises the role of primary health care in providing high quality, accessible care for patients with Type 2 diabetes throughout the country. It also highlights the importance of effective integrating services to prevent and care for diabetes into the current package of primary health care.
Currently, primary health care facilities identify approximately 10% of the estimated cases of Type 2 diabetes in Pakistan. It is vital that this care is strengthened through providing a public health approach, combining standardised quality care that includes screening, education, medication and adherence support.
This study will compare the treatment success and adherence in adults with Type 2 diabetes, including those with cardiovascular disease, who receive care from strengthened health care facilities with those receiving routine care.
Secondary objectives include:

  • comparing the case finding rates for type 2 diabetes
  • comparing the mean treatment success
  • comparing the mean hypertension control and total cholesterol achieved in adult Type 2 diabetes patients, with associated hypertension and hyper-cholesterol conditions
  • conducting an incremental cost effectiveness analysis of managing adult Type 2 diabetes patients at primary health care facilities in Punjab
  • informing the provincial strategic plan for managing Type 2 diabetes and associated hypertension and hyper-cholesterol conditions in Punjab

Potential outcomes
We aim to develop a training package for health care workers and tools for the performance management of health care facilities. The package will be implemented in select primary health care facilities in Punjab Province and evaluated for effectiveness and feasibility. A randomised control trial will compare the care in the facilities using the new approach compared to the facilities delivering usual care.
For more information, email hsdteam@asd.com.pk

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