Our objective in this study is two-fold:

1. Understanding the current private provider practices for hypertension care in Telangana.

1. Outlining interventions targeted at engaging private providers to manage hypertension better such that it is incentive compatible for them.

We will primarily study the screening, diagnosis, treatment, management, monitoring, and counseling practices for hypertension care provided by private providers in Telangana. We will understand the cost structure and the revenues earned by providers towards delivering hypertension care. We will also gather data on information systems used by the providers and their methodology of keeping track of visiting hypertensive patients. Pharmacists will be asked for information on their role in providing services like dispensing medication, generic substitution, over-the-counter medical advice, etc. For laboratories, we will study the services provided towards diagnosis and regular check-up of hypertension patients. The current state assessment will help us understand the critical factors influencing private sector hypertension care, and the prospective interventions would then be outlined that would be aimed at strengthening care delivery across the hypertension value chain.

Primary means of data collection is semi-structured interviews with the participants. The discussions will assist in building causal inferences. We will also use the following sources of evidence to help close the gaps in information received from semi-structured interviews.

1. Direct Observations: The study team will inconspicuously occupy a place within provider workspace to observe the interaction of the provider with other stakeholders such as patients, pharmacies, etc. The observations provide a better understanding of context as well as covers events in real time.
2. Archival Records: Analysis of physical documentation available that is directly related to the case study topic. These include but are not limited to patient prescriptions, consultation fee records, and pharmacy drug sale data. The records will provide quantitative evidence to back the other forms of evidence.
3. Physical Artifacts: These aren’t focused specifically on hypertension management but will assist in providing insights into awareness and communication among the participants. Few examples of such artifacts are posters at the clinic or pharmacy and IT systems used by providers. The study is not reliant on physical artifacts being always available but will help in closing gaps in the study.

We will interact with thirty private providers, thirty patients, six pharmacies, two diagnostic laboratories, and four pharmaceutical sales representatives.

The study will help us gain insights into the current private provider practices for hypertension care in Telangana. Involving private providers is critical in hypertension care as an estimated 80% of hypertension patients visit private providers for treatment. Therefore, it is imperative to understand the role of private providers in the awareness, diagnosis, and treatment of hypertension in India. The current practices among private providers include prescription of more than required diagnostic tests, and multiple drugs. Moreover, provider hopping and sub-optimal follow-ups by patients increase diagnostic delays and repeat cycles for testing. These practices impact treatment initiation, as well as drug adherence among private patients. We hypothesize that a targeted intervention among private providers can increase the number of patients under hypertension management. The understanding of private provider practices will shed light into ways to incentivize providers for better hypertension management.