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.

Autor:	Shekar S; Norwich Medical School, University of East Anglia, Norwich, UK.; Norfolk and Norwich University Hospital NHS Trust, Norwich, UK., Bachmann MO; Norwich Medical School, University of East Anglia, Norwich, UK M.Bachmann@uea.ac.uk., Bateman ED; Knowledge Translation Unit, Department of Medicine & Department of Pulmonology, University of Cape Town, Cape Town, South Africa., Stelmach R; School of Medicine, University of Sao Paulo, São Paulo, Brazil., Cruz AA; ProAR - Universidade Federal da Bahia, Salvador, Brazil., Zonta R; Gerência de Integração Assistencial, Secretaria Municipal da Saúde, Sao Paulo, Brazil., Pacheco de Andrade M; Gerência de Integração Assistencial, Secretaria Municipal da Saúde, Sao Paulo, Brazil., Zepeda J; Public Health, City of Bradford Metropolitan District Council, Bradford, UK., Cornick RV; Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa., Wattrus C; Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa., Georgeu-Pepper D; Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa., Anderson LF; Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa., Lombard C; Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa.; Division of Epidemiology and Biostatistics, Stellenbosch University, Stellenbosch, South Africa., Fairall LR; Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa.; School of Life Course & Population Sciences, King's College London, London, UK.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2024 Oct 28; Vol. 9 (Suppl 3). Date of Electronic Publication: 2024 Oct 28.
DOI:	10.1136/bmjgh-2023-013819
Abstrakt:	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. Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and declare that CW, LRF, DG-P, LFA, RVC and EDB are employees of the KTU. RZ and MPdA are employees of the City Health Department, Florianópolis, Brazil. JZ was an employee of the City Health Department, Florianópolis, Brazil during the initial agreement and adaptation of PACK in Florianópolis. AAC reports grants, personal fees and non-financial support from GSK, personal fees and non-financial support from AstraZeneca, personal fees and non-financial support from Boehringer Ingelheim, personal fees and non-financial support from MEDA, personal fees and non-financial support from Novartis, personal fees and non-financial support from EUROFARMA, personal fees and non-financial support from CHIESI, personal fees and non-financial support from Boston Scientific, outside the submitted work. EDB reports grants to institution for clinical trials from Novartis, Boehringer Ingelheim, Merck, Takeda, GlaxoSmithKline, Hoffmann La Roche, Actelion, Chiesi, Sanofi-Aventis, Cephalon, TEVA and AstraZeneca and personal fees from ICON, Novartis, Cipla, Vectura, Cipla, Menarini, ALK, ICON, Sanofi Regeneron, Boehringer Ingelheim and AstraZeneca, outside the submitted work, and is a Member of Global Initiative for Asthma Board and Science Committee. RS reports grants for clinical trials, personal, institution fees and non-financial support from AstraZeneca, and personal fees and non-financial support from Novartis, Boehringer Ingelheim, CHIESI and EUROFARMA. Between 2015 and 2020, the KTU and BMJ were engaged in a non-profit strategic partnership to provide continuous evidence updates for PACK, expand PACK-related supported services to countries and organisations as requested, and where appropriate license PACK content. The KTU and BMJ co-funded core positions, including a PACK Global Development Director, and received no profits from the partnership. PACK receives no funding from the pharmaceutical industry. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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