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Shekar, Sameer, Bachmann, Max Oscar 
ORCID: https://orcid.org/0000-0003-1770-3506, Bateman, Eric D., Stelmach, Rafael, Cruz, Álvaro Augusto, Zonta, Ronaldo, Pacheco de Andrade, Matheus, Zepeda, Jorge, Cornick, Ruth Vania, Wattrus, Camilla, Georgeu-Pepper, Daniella, Anderson, Lauren Faye, Lombard, Carl and Fairall, Lara R.
(2024)
Effects of PACK training on the management of asthma and chronic obstructive pulmonary disease by primary care clinicians during two years of implementation in Florianópolis, Brazil: extended follow-up after a pragmatic cluster randomised controlled trial with a stepped wedge design.
BMJ Global Health, 9 (Suppl 3).
ISSN 2059-7908
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Abstract
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: i) no intervention, ii) no intervention, iii) intervention, or Sequence B: i) no intervention, ii) intervention, iii) 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 (Odds Ratio adjusted for calendar time (OR) 1.29, 95% confidence interval (CI) 1.02–1.64) and more spirometry ordering (OR 1.55, (1.22-1.97)) in asthma patients, and with more spirometry ordering (OR 1.50, (1.15-1.96)) in COPD patients. Change in asthma treatment was more likely during the first and second year of exposure to training compared with no exposure (ORs 1.43, (1.09–1.87); 1.91, (1.21–3.02)), respectively. Spirometry was more likely during the first and second year of exposure in asthma patients, (ORs 1.76, (1.17–1.93); 2.05 95% (1.32–3.19)), and in COPD patients (ORs 1.57 (1.18–2.10)); 1.71 (1.08–2.70)). 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 two years.
| Item Type: | Article |
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| Additional Information: | Data availability statement: No data are available. Data are electronic medical records held by the Florianópolis and are not publicly available. Funding information: This work was supported by the Florianópolis City Health Department, which funded in-country localisation of PACK Adult, printing of the PACK guide, training and clinical support. Use of PACK Global Adult guide and associated materials was provided free of charge to Florianópolis City Health Department by BMJ Publishing Group on behalf of the Knowledge Translation Unit. Mentoring of the localisation of the guide and training materials by the Knowledge Translation Unit was funded by the Peter Sowerby Foundation (http://www.petersowerbyfoundation.com/) as part of development of a localisation toolkit for PACK. This paper forms part of a Collection on PACK sponsored by the UK’s National Institutes for Health and Care Research (NIHR) (NIHR201816) using UK aid from the UK government to profile the contribution of PACK across several countries towards the realisation of comprehensive primary healthcare as envisaged in the Declarations of Alma Ata and Astana and towards Universal Health Coverage and the Sustainable Development Goals. |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Centres > Population Health |
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| Depositing User: | LivePure Connector |
| Date Deposited: | 12 Nov 2024 12:30 |
| Last Modified: | 18 Nov 2024 09:30 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/97645 |
| DOI: | 10.1136/ bmjgh-2023-013819 |
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