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 Florianopolis, Brazil
Carregando...
Citações na Scopus
7
Tipo de produção
article
Data de publicação
2019
Título da Revista
ISSN da Revista
Título do Volume
Editora
BMJ PUBLISHING GROUP
Autores
BACHMANN, Max Oscar
BATEMAN, Eric D.
CRUZ, Alvaro A.
ANDRADE, Matheus Pacheco de
ZONTA, Ronaldo
ZEPEDA, Jorge
NATAL, Sonia
CORNICK, Ruth Vania
WATTRUS, Camilla
Citação
BMJ GLOBAL HEALTH, v.4, n.6, article ID e001921, 13p, 2019
Resumo
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 Florianopolis 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.
Palavras-chave
Referências
- [Anonymous], 2018, GLOB STRAT ASTHM MAN
- Awotiwon A, 2018, BMJ GLOB HEALTH, V3, DOI 10.1136/bmjgh-2018-001079
- Bachmann MO, 2018, J THORAC DIS, V10, P4667, DOI 10.21037/jtd.2018.07.34
- Casas A, 2018, INT J CHRONIC OBSTR, V13, P1545, DOI 10.2147/COPD.S154097
- Cerci Neto Alcindo, 2008, J. bras. pneumol., V34, P639, DOI 10.1590/S1806-37132008000900002
- Cornick R, 2018, BMJ GLOB HLTH, V3
- Cornick R, 2018, BMJ GLOB HEALTH, V3, DOI 10.1136/bmjgh-2018-000962
- Fairall L, 2018, BMJ GLOB HLTH, V3
- Fairall L, 2012, LANCET, V380, P889, DOI 10.1016/S0140-6736(12)60730-2
- Fairall LR, 2017, SAMJ S AFR MED J, V107, P278, DOI [10.7196/SAMJ.2017.v107i4.12413, 10.7196/samj.2017.v107i4.12413]
- Fairall LR, 2016, PLOS MED, V13, DOI 10.1371/journal.pmed.1002178
- Fairall LR, 2005, BMJ-BRIT MED J, V331, P750, DOI 10.1136/bmj.331.7519.750
- Haines A, 2000, PERSONAL INFORM MED
- Keynejad RC, 2018, BMJ GLOB HEALTH, V3, DOI 10.1136/bmjgh-2018-001073
- Marinho F, 2018, LANCET, V392, P760, DOI 10.1016/S0140-6736(18)31221-2
- Maspero JF, 2013, WORLD ALLERGY ORGAN, V6, DOI 10.1186/1939-4551-6-19
- Massuda A, 2018, BMJ GLOB HEALTH, V3, DOI 10.1136/bmjgh-2018-000829
- Medical Research Council, 2002, CLUST RAND TRIALS ME
- Ponte EV, 2018, LUNG, V196, P643, DOI 10.1007/s00408-018-0158-y
- Ponte EV, 2018, CLIN RESPIR J, V12, P410, DOI 10.1111/crj.12530
- Reeves S, COCHRANE DATABASE SY, V19
- Rowe AK, 2018, LANCET GLOB HEALTH, V6, pE1163, DOI 10.1016/S2214-109X(18)30398-X
- Rzewuska M, 2017, PLOS ONE, V12, DOI 10.1371/journal.pone.0171813
- Simelane ML, 2018, BMJ GLOB HEALTH, V3, DOI 10.1136/bmjgh-2018-001124
- Souza-Machado C, 2010, EUR RESPIR J, V35, P515, DOI 10.1183/09031936.00101009
- To T, 2012, BMC PUBLIC HLTH, V12
- Tsima BM, 2016, J MULTIDISCIP HEALTH, V9, DOI 10.2147/JMDH.S112466
- Vogelmeier CF, 2017, AM J RESP CRIT CARE, V195, P557, DOI 10.1164/rccm.201701-0218PP
- Wattrus C, 2018, BMJ GLOB HEALTH, P3
- Wranik WD, 2019, HEALTH POLICY, V123, P550, DOI 10.1016/j.healthpol.2019.03.015
- Teixeira PJZ, 2019, J BRAS PNEUMOL, V45, DOI 10.1590/1806-3713/e20190037
- Zwarenstein M, 2011, BMJ-BRIT MED J, V342, DOI 10.1136/bmj.d2022