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

Pracheth Raghuveer; Tanu Anand; Jaya Prasad Tripathy; Abhay Subhashrao Nirgude; Mahendra M Reddy; Subhashree Nandy; Habeena Shaira; Poonam Ramesh Naik

doi:10.12688/f1000research.22825.1

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

F1000Res. 2020 May 6:9:335. doi: 10.12688/f1000research.22825.1. eCollection 2020.

Authors

Pracheth Raghuveer¹, Tanu Anand², Jaya Prasad Tripathy³, Abhay Subhashrao Nirgude¹, Mahendra M Reddy⁴, Subhashree Nandy¹, Habeena Shaira¹, Poonam Ramesh Naik¹

Affiliations

¹ Department of Community Medicine, Yenepoya Medical College , Yenepoya (Deemed to be University), Mangaluru, Karnataka, 575018, India.
² Indian Council of Medical Research (ICMR), Department of Health Research, Ministry of Health and Family Welfare,, New Delhi, Delhi, 110029, India.
³ Department of Community Medicine, All India Institute of Medical Sciences (AIIMS), Nagpur, Maharashtra, 441108, India.
⁴ Department of Community Medicine, Sri Devraj Urs Medical College, Sri Devraj Urs Academy of Higher Education and Research (SDUAHER), Kolar, Karnataka, 563103, India.

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.

Keywords: SORT IT; early detection; lifestyle diseases; operational research; opportunistic screening.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Diabetes Mellitus* / diagnosis
Diabetes Mellitus* / epidemiology
Female
Humans
Hypertension* / diagnosis
Hypertension* / epidemiology
India / epidemiology
Male
Mass Screening*
Middle Aged
Primary Health Care

Associated data

figshare/10.6084/m9.figshare.12052950
figshare/10.6084/m9.figshare.12053055

Grants and funding

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).