Opportunistic screening for diabetes mellitus and hypertension in primary care settings in Karnataka, India: a few steps forward but still some way to go

Abstract

Background: Opportunistic screening for individuals aged ≥30 years at all levels of healthcare for early detection of diabetes mellitus (DM) and hypertension (HTN) is an integral strategy under the national program to control non-communicable diseases. There has been no systematic assessment of the screening process in primary care settings since its launch. The objective was to determine the number and proportion eligible for screening, number screened, diagnosed and treated for DM and HTN among persons aged ≥30 years in two selected primary health centres (PHCs) in Dakshina Kannada district, Karnataka, India during March-May 2019 and to explore the enablers and barriers in the implementation of screening from the perspective of the health care providers (HCPs) and beneficiaries . Methods: This was a sequential explanatory mixed-methods study with a quantitative (cohort design) and a descriptive qualitative component (in-depth interviews and focus group discussions) with HCPs and persons seeking care. Those that were not known DM/HTN and not screened for DM/HTN in one year were used to estimate persons eligible for screening. Results: Of 2697 persons, 512 (19%) were eligible for DM screening, 401 (78%) were screened; 88/401 (22%) were diagnosed and 67/88 (76%) were initiated on treatment. Of 2697, 337 (13%) were eligible for HTN screening, 327 (97%) were screened, 55 (17%) were diagnosed with HTN; of those diagnosed, 44/55 (80%) were initiated on treatment. The documentation changes helped in identifying the eligible population. Patient willingness to undergo screening and recognition of relevance of screening were screening enablers. Overworked staff, logistical and documentation issues, inadequate training were the barriers. Conclusion: Nearly 19% were eligible for DM screening and 13% were eligible for HTN screening. The yield of screening was high. We noted several enablers and barriers. The barriers require urgent attention to reduce the gaps in delivery and uptake of services.

Opportunistic Screening for Hypertension and Obesity among Patients Attending a Tertiary Care Hospital in Bangalore, India

“…Other study reported the prevalence of hypertension to be 17%, 17.9%, 21.5%, while another study reported it to be 41.3%. 5,[9][10][11] Hypertension is a risk factor for cardiovascular diseases. The presence of this health condition may go unnoticed for long years, while opportunistic screening is simple, yet efficient method for screening hypertension.…”

“…All Patients aged 30 years and above, who attended the Outpatient department of General Medicine were enrolled in the study • Sample size: In a previous study, 17% of the people were diagnosed to be hypertensive on screening. 5 With 5% absolute precision and 95% confidence, design effect of 1; sample size was calculated to be 217. Sample size was calculated using Open Epi.…”

“…Part 1: Socio-demographic profile and different factors associated with hypertension and obesity were included in the questionnaire, based on literature review. 5,9 Part 2: Measurement of BP, Height, Weight, BMI, Waist circumference.…”

Need for HTA supported risk factor screening for hypertension and diabetes in Nepal: A systematic scoping review

“…Similarly, it would be wise to compare the cost in lieu of the yield and the diagnoses that the screening strategies give. In an ambulatory high-risk approach carried out in the Bhutan PEN evaluation study ( 19 ), a 10% of eligibility and around 23% of diagnosis for HTN and a 10% of eligibility and 26% of diagnosis for DM may be contrasted with a 13% of eligibility and 17% of diagnosis for HTN and a 19% of eligibility and 22% of diagnosis in an opportunistic high-risk screening approach carried out in Karnataka, India ( 20 ). In these two studies, number of diagnoses was higher in ambulatory high-risk approach but yield was higher in opportunistic high-risk approach.…”

“…In Bhutan, an economic evaluation of the World Health Organization (WHO)'s Package of Essential Non-communicable diseases (PEN) found that the ambulatory but high-risk screening (where people who are overweight, obese, or >40 years for DM and/or HTN, visiting primary care facilities) represents good value for money compared to “no screening” ( 19 ). However, if performed on a regular basis and taking into account the specific population group and the existing non-disease to disease conversion rate, opportunistic high-risk approach screening may also yield high results (but may not confirm cases) ( 20 ).…”