Primary care perspectives: a descriptive study of primary care health systems and physicians treating cardiovascular disease and risk factors in Karnataka, south India.
Creators: name: Dill, Anna
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2014

description: Purpose: This paper represents the conception and analysis of a mixed methods descriptive study that sought to voice the opinions of a small group of primary care physicians in and around Bangalore, south India about the management of cardiovascular and chronic disease. Furthermore, it seeks to put these opinions in context of the documented changing role of the primary health care system in both low/middle income and high-income countries as chronic and non-communicable diseases of all classes dominate the health care services industry. "Lessons learned" from conducting quantitative and qualitative research with a relatively under reported focus group (primary care physicians in urban India) are discussed in the final section. Background: Non-communicable diseases (of which cardiovascular disease is the largest fraction) have been the commonest cause of death globally for the past three decades (Hunter and Reddy 2013). Modifying known controllable risk factors such as diet, physical activity, hypertension, diabetes, dyslipidemia, and tobacco use comprise the leading preventative efforts for chronic disease; although exactly how these messages are portrayed vary. The role of the primary health care provider is a potentially powerful mediator to patients in terms of preventing chronic disease, but research resources available to the study of chronic disease particularly in low and middle-income countries have been scarce (Ebrahim, Pearce et al. 2013) Methods: This author surveyed 50 primary care physicians individually in and around Bangalore, India. Out of all physicians that completed the survey, 28 primary care physicians agreed to an additional in-depth semi structured interview that focused on changes in practice in regards to a growing chronic disease burden. Quantitative data was analyzed initially with Qualtrics survey software and Excel to provide a descriptive analysis of the data set, while quantitative data analyzed through DeDoose software was used to triangulate prominent findings. Results: Physicians agreed on several barriers to providing cardiovascular disease (CVD) care: cost and access to medications at the patient level (56%), and the lack of focus on preventative and primary care at the policy level (62%). Additionally, physicians agreed on several possible strategies to overcome barriers. At the patient level, physicians agreed that increasing patient education materials at point of care would be useful (80%). At the physician level, the study found survey participants overwhelmingly identified with increasing continuing medical education (80%) and targeted medical education updates in CVD care (76%) as strategies for improvement. At the policy level, physicians in the study agreed that increased access to insurance policies for patients would be helpful (68%). These findings were confirmed and widened in qualitative interview. Also, there were several survey components many physicians disagreed on, although those disagreements did not appear to differ between practice and physicians demographic characteristics, although strata in data set are too small for significant bivariate analysis. A number of themes emerged solely from qualitative interview that were not included in the survey. The topics of non-allopathic primary care, specialist coordination, and increasing measures to legitimize primary care as an academic specialty were common themes that were repeated among the 28 physicians that agreed to in-depth interview.