Management of patients with obstructive lung disease in South India: a retrospective study of spirometry and bronchodilator use in an urban health centre

Abstract

Background: Based on the burden of obstructive lung diseases program (BOLD), the global prevalence of chronic obstructive pulmonary disease (COPD) was 11.7% in which 90% of the deaths occur in low- and middle-income countries. India and China are estimated to account for 66% of total global COPD mortality. The Indian Chest Society (ICS) recommends spirometry to document irreversible airflow limitation in patients suspected of having COPD. However, the reported usage of spirometry among primary care physicians in India is only 10-20% as primary health care centers in India are not equipped with spirometry or inhaler devices.Methods: A retrospective study was done on patients treated for respiratory symptoms with bronchodilators at an urban health centre to document the practice pattern of primary care physicians with regards to use of spirometry in patients on bronchodilators.Results: Of the 1196 patients on bronchodilators, spirometry was documented in 15.5%. Patients on inhalers, using more than one therapy and males less than 55 years were more likely to undergo spirometry. About 52.4% of patients who underwent spirometry were found to have post bronchodilator forced expiratory volume at first second (FEV1)/ forced vital capacity (FVC) less than 0.7 of which 43% had severe disease and 44% had poor post-broncho-dilator reversibility.Conclusions: Besides diagnostic spirometry, management guidelines for COPD should be complemented by health education to change patients’ perception of respiratory symptoms, increase awareness of COPD in those with risk factors and change their health seeking behaviour along with continuous professional development activities for primary care physicians.

Exploring networks of care in implementing midwife-led birthing centres in low- and middle-income countries: A scoping review

“…The integration of MLBCs within an established referral system improves confidence and a sense of safety among service users. Seventeen articles mentioned issues related to referral systems [ 5 , 20 , 21 , 23 – 26 , 30 , 39 – 41 , 46 – 48 , 50 – 52 ]. In all settings, some sort of referral system was in place, but in many cases, it did not function well due to a lack of ambulances and/or equipment and geographical challenges.…”

“…Key bottlenecks included midwife shortages, excessive workloads and a lack of clinical competencies, training, and professional autonomy. The studies also emphasised the need for continued professional development for MLBC midwives to maintain clinical skills and competencies [ 5 , 17 , 18 , 20 – 23 , 25 , 27 – 30 , 32 – 34 , 36 , 37 , 39 – 41 , 44 , 45 , 52 – 54 ].…”

“…The level of competence of providers and community satisfaction with MLBC services, were mentioned as important benchmarks of quality of care in 14 studies [ 17 , 21 , 22 , 33 , 34 , 37 – 39 , 41 , 44 , 47 , 48 , 50 , 52 ]. These studies suggest the need for improving the competencies of midwives working within MLBCs, with more emphasis on risk management and continuous professional development via in-service training and supportive supervision and mentoring.…”

“…The need for capacity building on risk management and emergency obstetric and neonatal care was emphasised by studies from Mexico, South Africa, and Sierra Leone [ 21 , 24 , 39 ]. Supportive supervision and mentorship with further capacity building improved clinical competence and effective risk management [ 22 , 41 , 47 , 52 ]. The studies highlighted that experienced and competent midwives add value to the MLBC environment and improve client satisfaction [ 34 , 37 ].…”

“…Eighteen studies indicated the barriers or facilitators for the use of guidelines in delivering evidence-based services [ 5 , 21 , 23 , 24 , 26 , 29 , 31 , 33 , 35 , 38 , 40 – 43 , 50 , 52 , 54 ]. In general, the findings relating to the use of guidelines and protocols and the ability of staff to implement and be compliant with evidence-based guidelines, within MLBCs was better than other types of health facilities.…”