Opportunistic screening for diabetes mellitus and hypertension in primary care settings in Karnataka, India: a few steps forward but still some way to go [version 1; peer review: 1 approved, 2 approved with reservations]

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 Open Peer Review Reviewer Status Invited Reviewers 1 2 3 version 1 06 May 2020 report report report Anindo Majumdar , All India Institute of Medical Sciences (AIIMS), Bhopal, India 1. Subita P. Patil , Tata Memorial Centre, HBNI, Mumbai, India 2. Mongal Singh Gurung , Ministry of Health, Thimphu, Bhutan 3. Any reports and responses or comments on the article can be found at the end of the article. Page 1 of 22 F1000Research 2020, 9:335 Last updated: 19 NOV 2020 Corresponding author: Pracheth Raghuveer (prach1986@gmail.com) Author roles: Raghuveer P: Conceptualization, Data Curation, Formal Analysis, Methodology, Project Administration, Resources, Software, Writing – Original Draft Preparation; Anand T: Conceptualization, Methodology, Writing – Review & Editing; Tripathy JP: Conceptualization, Formal Analysis, Methodology, Supervision, Validation, Visualization, Writing – Review & Editing; Nirgude AS: Conceptualization, Formal Analysis, Project Administration, Software, Supervision, Writing – Review & Editing; Reddy MM: Conceptualization, Formal Analysis, Software, Validation, Writing – Review & Editing; Nandy S: Conceptualization, Data Curation, Formal Analysis, Writing – Original Draft Preparation; Shaira H: Conceptualization, Data Curation, Formal Analysis, Writing – Original Draft Preparation; Naik PR: Conceptualization, Methodology, Supervision, Validation, Writing – Review & Editing Competing interests: No competing interests were disclosed. Grant information: The training programme and open access publications costs were funded by the Department for International Development (DFID), UK and La Foundation Veuve Emile Metz-Tesch (Luxembourg). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2020 World Health Organisation. This is an open access article distributed under the terms of the Creative Commons Attribution IGO License, which permits copying, adaptation and distribution in any medium or format for any purpose, provided the original work is properly cited, a link is provided to the license, and any changes made are indicated. Any such copying, adaptation and distribution must not in any way suggest that World Health Organisation endorses you or your use. How to cite this article: Raghuveer P, Anand T, Tripathy JP et al. Opportunistic screening for diabetes mellitus and hypertension in primary care settings in Karnataka, India: a few steps forward but still some way to go [version 1; peer review: 1 approved, 2 approved with reservations] F1000Research 2020, 9:335 https://doi.org/10.12688/f1000research.22825.1 First published: 06 May 2020, 9:335 https://doi.org/10.12688/f1000research.22825.1 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.