Effects of PACK guide training on the management of asthma and chronic obstructive pulmonary disease by primary care clinicians: a pragmatic cluster randomised controlled trial in Florianópolis, Brazil
Open Access
- 16 December 2019
- journal article
- research article
- Published by BMJ in BMJ Global Health
- Vol. 4 (6), e001921
- https://doi.org/10.1136/bmjgh-2019-001921
Abstract
Introduction The Practical Approach to Care Kit (PACK) guide was localised for Brazil, where primary care doctors and nurses were trained to use it. Methods Twenty-four municipal clinics in Florianópolis were randomly allocated to receive outreach training and the guide, and 24 were allocated to receive only the guide. 6666 adult patients with asthma or chronic obstructive pulmonary disease (COPD) were enrolled, and trial outcomes were measured over 12 months, using electronic medical records. The primary outcomes were composite scores of treatment changes and spirometry, and new asthma and COPD diagnosis rates. Results Asthma scores in 2437 intervention group participants were higher (74.8%, 20.4% and 4.8% with scores of 0, 1 and 2, respectively) than in 2633 control group participants (80.0%, 16.8% and 3.2%) (OR for higher score 1.32, 95% CI 1.08 to 1.61, p=0.006). Adjusted for asthma scores recorded in each clinic before training started, the OR was 1.24 (95% CI 1.03 to 1.50, p=0.022). COPD scores in 1371 intervention group participants (77.7%, 17.9% and 4.3% with scores of 0, 1 and 2) did not differ from those in 1181 control group participants (80.5%, 15.8% and 3.7%) (OR 1.21, 95% CI 0.94 to 1.55, p=0.142). Rates of new asthma and COPD diagnoses, and hospital admission, and indicators of investigation, diagnosis and treatment of comorbid cardiovascular disease, diabetes and depression, and tobacco cessation did not differ between trial arms. Conclusion PACK training increased guideline-based treatment and spirometry for asthma but did not affect COPD or comorbid conditions, or diagnosis rates. Trial registration NCT02786030 (https://clinicaltrials.gov/).This publication has 31 references indexed in Scilit:
- Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled TrialPLoS Medicine, 2016
- Developing the Botswana Primary Care Guideline: an integrated, symptom-based primary care guideline for the adult patient in a resource-limited settingJournal of Multidisciplinary Healthcare, 2016
- Urbanization is associated with increased asthma morbidity and mortality in BrazilThe Clinical Respiratory Journal, 2016
- Insights, attitudes, and perceptions about asthma and its treatment: findings from a multinational survey of patients from Latin AmericaWorld Allergy Organization Journal, 2013
- Task shifting of antiretroviral treatment from doctors to primary-care nurses in South Africa (STRETCH): a pragmatic, parallel, cluster-randomised trialThe Lancet, 2012
- Global asthma prevalence in adults: findings from the cross-sectional world health surveyBMC Public Health, 2012
- Outreach education for integration of HIV/AIDS care, antiretroviral treatment, and tuberculosis care in primary care clinics in South Africa: PALSA PLUS pragmatic cluster randomised trialBMJ, 2011
- Rapid reduction in hospitalisations after an intervention to manage severe asthmaEuropean Respiratory Journal, 2009
- Redução do número de internações hospitalares por asma após a implantação de programa multiprofissional de controle da asma na cidade de LondrinaJornal Brasileiro de Pneumologia, 2008
- Effect of educational outreach to nurses on tuberculosis case detection and primary care of respiratory illness: pragmatic cluster randomised controlled trialBMJ, 2005