Effects of Pack training on the management of asthma and chronic obstructive pulmonary disease by primary care clinicians during 2 years of implementation in Florianópolis, Brazil

Extended follow-up after a pragmatic cluster randomised controlled trial with a stepped-wedge design

Bibliographic Data

ID21879388
AuthorsSameer Shekar (0000-0002-8265-0685, University of East Anglia), M Bachmann (0000-0003-1770-3506, University of East Anglia), Eric D Bateman (0000-0002-5064-5849, University of Cape Town), Rafaël Stelmach (0000-0002-5132-1934, Universidade de São Paulo), Alvaro A Cruz (0000-0002-7403-3871, Universidade Federal da Bahia), Ronaldo Zonta (0000-0002-8877-7468, Secretaria Municipal de Saúde), Matheus Pacheco de Andrade (0000-0002-3184-5634, Secretaria Municipal de Saúde), Joseph Zepeda (0000-0002-3279-0372, City of Bradford Metropolitan District Council), Jorge Zepeda (0000-0002-8098-6169, Public Health, City of Bradford Metropolitan District Council, Bradford, UK), Ruth Cornick (0000-0002-7391-3383, University of Cape Town), Camilla Wattrus (0000-0002-2075-7903, University of Cape Town), Daniella Georgeu-Pepper (0000-0003-2745-7820, University of Cape Town), Lauren Faye Anderson (0009-0008-3655-9822, University of Cape Town), Chantal Lombard (0000-0002-2136-6533, South African Medical Research Council), L Fairall (0000-0002-7460-4670, University of Cape Town)
Year2024
Volume9
IssueSuppl 3
Pagese013819
Publication date2024-10-01
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2023-013819
PMID39467591
OpenAlexW4403843437
LanguageEN
Citations received4
References cited34

BACKGROUND: Training primary care doctors and nurses to use Practical Approach to Care Kit (PACK) improved management of asthma and chronic obstructive pulmonary disease (COPD) in a previous randomised trial. The present study examined the training effects including a second year of follow-up with expanded coverage of repeated training sessions. METHODS: Using a stepped-wedge cluster randomised trial design, 48 clinics were randomly allocated either to sequence A: (1) no intervention, (2) no intervention, (3) intervention or sequence B: (1) no intervention, (2) intervention, (3) intervention, during three 12-month periods. Primary outcomes were change in treatment and spirometry ordering. Effects of any exposure to the training, and of exposure to the first and second years of training, were estimated with mixed effect logistic regression models. RESULTS: Any exposure to training was associated with increased changes in treatment (OR adjusted for calendar time (OR) 1.29, 95% CI 1.02 to 1.64) and more spirometry ordering (OR 1.55, (95% CI 1.22 to 1.97)) in asthma patients, and with more spirometry ordering (OR 1.50 (95% CI 1.15 to 1.96)) in patients with COPD. Change in asthma treatment was more likely during the first and second year of exposure to training compared with no exposure (ORs 1.43 (95% CI 1.09 to 1.87); 1.91 (95% CI 1.21 to 3.02)), respectively. Spirometry was more likely during the first and second year of exposure in asthma patients (ORs 1.76 (95% CI 1.34 to 2.30); 2.05 (95% CI 1.32 to 3.19)) and in patients with COPD (ORs 1.57 (95% CI 1.18 to 2.10)); 1.71 (95% CI 1.08 to 2.70)). CONCLUSION: Extended follow-up suggested that PACK training continued to be effective in improving chronic respiratory care and that effective intervention delivery was sustainable for 2 years. TRIAL REGISTRATION NUMBER: NCT02786030

Asthma · COPD · Family medicine · Logistic regression · Physical therapy · Primary care · Randomized controlled trial · Spirometry · Asthma and respiratory diseases · Chronic Obstructive Pulmonary Disease (COPD) Research · Delphi Technique in Research · Medicine · Internal Medicine

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