ArticleBMC health services research2018
Integrating a diabetes and hypertension case management package within primary health care: a mixed methods feasibility study in Bangladesh.
Article in BMC health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- Implementation strategies for evidence-based management of type 2 diabetes at primary healthcare facilities in low- and middle-income countries and related barriers and facilitators: a scoping review.Implementation science communications · 2026Pooled it
- Barriers and facilitators to integrating non-communicable disease care within primary healthcare systems in low-resource countries: a systematic review.BMC health services research · 2026Pooled it
- Integration of Cardiovascular Disease Services within Primary Health Care Systems: Insights from South Asia.Current atherosclerosis reports · 2026Review
- Co-creation, co-design or co-production? Reflections on the development of urban health systems implementation strategies to improve access and quality of primary healthcare services in Bangladesh, Ghana, Nepal and Nigeria.Health research policy and systems · 2026Article
- Cascade of care for type 2 diabetes mellitus and hypertension in rural Bangladesh: sub-regional mapping of gaps in care.BMJ public health · 2026Article
- Article
- Continuity of care for people with hypertension in primary health care: a scoping review.Revista da Escola de Enfermagem da U S P · 2026Article
- Understanding the role and organization of health workers delivering non-communicable disease management in primary care in low- and middle-income countries: a scoping review.BMC primary care · 2025Article
- Delivering non-communicable disease services through primary health care in selected south Asian countries: are health systems prepared?The Lancet. Global health · 2024Review
- Experiences of access and use of primary health care by users with systemic arterial hypertension.Revista da Escola de Enfermagem da U S P · 2024Article
- Perceptions of the primary health care team about the implementation of integrated care of patients with type 2 diabetes and hypertension in Slovenia: qualitative study.BMC health services research · 2023Article
- Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study.Healthcare (Basel, Switzerland) · 2023Article
- The Voice of Patients Really Matters: Using Patient-Reported Outcomes and Experiences Measures to Assess Effectiveness of Home-Based Integrated Care-A Scoping Review of Practice.Healthcare (Basel, Switzerland) · 2022Article
- Preference and willingness to receive non-communicable disease services from primary healthcare facilities in Bangladesh: A qualitative study.BMC health services research · 2022Article
- Primary Health Care System Strengthening Project in Sri Lanka: Status and Challenges with Human Resources, Information Systems, Drugs and Laboratory Services.Healthcare (Basel, Switzerland) · 2022Article
- Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries.BMJ global health · 2019Review
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlmost three quarters of non-communicable disease (NCD) deaths, and 82% of premature NCD deaths, occur in low- and middle-income countries. Bangladesh has an estimated 7 million hypertensives and 10 million diabetics, and primary care is struggling to respond. Our aim was to develop and support implementation of a diabetes and hypertension case management package, and assess its appropriateness, feasibility and acceptability in two NCD clinics within two primary-care centres in Bangladesh.
methodsWe used a convergent mixed methods design. We first assessed the level of appropriate hypertension and cardiovascular disease patient management, based on a composite outcome indicator using data from patients' treatment cards. Appropriate management was primarily informed by International Diabetes Federation (IDF) and World Health Organisation (WHO) guidelines. We then performed qualitative in-depth interviews with doctors and patients to explain these quantitative findings and to understand the challenges to achieving appropriate patient management in the NCD clinics.
resultsEighty-one newly diagnosed patients were recruited. Over 3 months, 53.1% (95% CI 42.3% to 63.6%) of patients were appropriately managed. We found incomplete diagnosis (especially missing hypertension diagnosis alongside diabetes) and non-provision of follow-up appointments were the main causes of the relatively low level of appropriate management. We conducted interviews with 11 patients and 8 health professionals and found a shortage of human resources, reporting materials, available drugs and diagnostic equipment. This undermined patients' willingness to attend clinics and doctors' willingness to offer follow-ups. Hands-on skill-building training was valuable in increasing doctors' competence for appropriate management, but was seen as a novel training method and faced constraints to implementation.
conclusionsA clinical guide, skill-based training and recording package can be implemented in routine primary care and can lead to appropriate management of around half of diabetic and hypertensive patients in a low-income country. However, considerable health systems challenges must be addressed before more patients can be managed appropriately.
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