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
IntroductionThe Practical Approach to Care Kit (PACK) guide was localised for Brazil, where primary care doctors and nurses were trained to use it.MethodsTwenty-four municipal clinics in Florianópolis were randomly allocated to receive outreach training and the guide, and 24 were allocated to receiv...
Main Authors: | , , , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMJ Publishing Group
2019-11-01
|
Series: | BMJ Global Health |
Online Access: | https://gh.bmj.com/content/4/6/e001921.full |
id |
doaj-ad1d2e1828494a61b0fe264fd465ce61 |
---|---|
record_format |
Article |
spelling |
doaj-ad1d2e1828494a61b0fe264fd465ce612021-03-25T15:30:36ZengBMJ Publishing GroupBMJ Global Health2059-79082019-11-014610.1136/bmjgh-2019-001921Effects 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, BrazilCarl Lombard0Ruth Vania CornickCamilla WattrusLauren AndersonMax Oscar Bachmann1Eric D BatemanRafael StelmachAlvaro A CruzMatheus Pacheco de AndradeRonaldo ZontaJorge ZepedaSonia NatalDaniella Georgeu-PepperLara R Fairall4 Biostatistics Research Unit, South African Medical Research Council, Tygerberg, South Africa Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UKIntroductionThe Practical Approach to Care Kit (PACK) guide was localised for Brazil, where primary care doctors and nurses were trained to use it.MethodsTwenty-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.ResultsAsthma 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.ConclusionPACK training increased guideline-based treatment and spirometry for asthma but did not affect COPD or comorbid conditions, or diagnosis rates.Trial registrationNCT02786030 (https://clinicaltrials.gov/).https://gh.bmj.com/content/4/6/e001921.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Carl Lombard Ruth Vania Cornick Camilla Wattrus Lauren Anderson Max Oscar Bachmann Eric D Bateman Rafael Stelmach Alvaro A Cruz Matheus Pacheco de Andrade Ronaldo Zonta Jorge Zepeda Sonia Natal Daniella Georgeu-Pepper Lara R Fairall |
spellingShingle |
Carl Lombard Ruth Vania Cornick Camilla Wattrus Lauren Anderson Max Oscar Bachmann Eric D Bateman Rafael Stelmach Alvaro A Cruz Matheus Pacheco de Andrade Ronaldo Zonta Jorge Zepeda Sonia Natal Daniella Georgeu-Pepper Lara R Fairall 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 BMJ Global Health |
author_facet |
Carl Lombard Ruth Vania Cornick Camilla Wattrus Lauren Anderson Max Oscar Bachmann Eric D Bateman Rafael Stelmach Alvaro A Cruz Matheus Pacheco de Andrade Ronaldo Zonta Jorge Zepeda Sonia Natal Daniella Georgeu-Pepper Lara R Fairall |
author_sort |
Carl Lombard |
title |
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 |
title_short |
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 |
title_full |
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 |
title_fullStr |
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 |
title_full_unstemmed |
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 |
title_sort |
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 |
publisher |
BMJ Publishing Group |
series |
BMJ Global Health |
issn |
2059-7908 |
publishDate |
2019-11-01 |
description |
IntroductionThe Practical Approach to Care Kit (PACK) guide was localised for Brazil, where primary care doctors and nurses were trained to use it.MethodsTwenty-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.ResultsAsthma 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.ConclusionPACK training increased guideline-based treatment and spirometry for asthma but did not affect COPD or comorbid conditions, or diagnosis rates.Trial registrationNCT02786030 (https://clinicaltrials.gov/). |
url |
https://gh.bmj.com/content/4/6/e001921.full |
work_keys_str_mv |
AT carllombard effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil AT ruthvaniacornick effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil AT camillawattrus effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil AT laurenanderson effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil AT maxoscarbachmann effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil AT ericdbateman effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil AT rafaelstelmach effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil AT alvaroacruz effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil AT matheuspachecodeandrade effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil AT ronaldozonta effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil AT jorgezepeda effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil AT sonianatal effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil AT daniellageorgeupepper effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil AT lararfairall effectsofpackguidetrainingonthemanagementofasthmaandchronicobstructivepulmonarydiseasebyprimarycarecliniciansapragmaticclusterrandomisedcontrolledtrialinflorianopolisbrazil |
_version_ |
1724203441596661760 |