Lung Health Care pilot project trims patient pill load and antibiotic prescription in primary health care settings in Kerala, India

Indian J Tuberc. 2020 Apr;67(2):202-207. doi: 10.1016/j.ijtb.2020.02.001. Epub 2020 Feb 17.


Introduction: Kerala, the southern Indian state piloted Lung Health Care Project (LHCP) which is a locally adopted version of WHO recommended Practical Approach to Lung health (PAL). The current study assessed the impact of the project on the prescribing practices of doctors and consumption of antibiotics and other drugs.

Methods: This study compared performance of primary health care institutions with regard to drug prescriptions and consumptions before and after the implementation of the project. Chronic respiratory disease (CRD) patients in institutions implemented the project were interviewed in the OPD at exit and their prescriptions were documented at baseline and after six months. Focus group discussions were conducted with doctors to explore the reasons behind changes in drug consumption pattern.

Results: In the project implementing institutions, mean number of drugs prescribed for CRDs was 3.88 (SD 1.50) and 2.73 (SD 1.18) at baseline and after six months respectively (p < 0.001). Adjusted odds ratio for prescribing an antibiotic and injection to a CRD patient during impact assessment at institutions implementing project was 0.34 (95% CI 0.15-0.75 p 0.008) and 0.39 (95% CI 0.20-0.74 p 0.004) respectively, as compared to baseline. The factors which helped in reducing antibiotic and injection use as felt by the doctors were presence of a protocol, good quality trainings, supportive supervision and monitoring, availability of alternate drugs and good participation of staff nurses especially in-patient education.

Conclusion: Strict adherence to diagnostic and management algorithms of Lung health care project in a primary health care setting in India helped in reducing pill burden to patients and prescription of antibiotics and injections.

Keywords: Antibiotics; Chronic respiratory diseases; Practical approach to lung-health; Prescription drugs; Primary health care.

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Asthma / drug therapy*
  • Bronchodilator Agents / administration & dosage*
  • Bronchodilator Agents / therapeutic use
  • Dexamethasone / administration & dosage
  • Dexamethasone / therapeutic use
  • Female
  • Focus Groups
  • Glucocorticoids / administration & dosage*
  • Glucocorticoids / therapeutic use
  • Humans
  • Hydrocortisone / administration & dosage
  • Hydrocortisone / therapeutic use
  • India
  • Male
  • Middle Aged
  • Physicians
  • Pilot Projects
  • Polypharmacy
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'*
  • Primary Health Care*
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Theophylline / administration & dosage*
  • Theophylline / therapeutic use


  • Anti-Bacterial Agents
  • Bronchodilator Agents
  • Glucocorticoids
  • Dexamethasone
  • Theophylline
  • Hydrocortisone