Abstract
Objective: The mere dissemination of standard care recommendations has been insufficient to improve clinical results in patients with asthma. The objective of the present study was to evaluate the clinical effectiveness of a multifaceted asthma distance education for primary care providers. Methods: Cluster randomized controlled trial. Full primary care teams were included if they had access to telehealth support and free basic asthma treatment. Before randomization, selected teams indicated asthma patients between 5-45 years old for inclusion. The intervention group received three interactive online sessions, printed educational material, reminders, booklet for patients, and frequent stimulus to use consulting services. The control group received no intervention. Symptomfree days per two weeks was the primary result. Controlled asthma, unscheduled asthma doctor visits, and preventive inhaled corticosteroid use were the secondary results. Six months after intervention, the results were compared with baseline data using generalized estimating equations for repeated measures and clustering effect. Results: Were enrolled 71 primary care teams and 443 individuals. Most patients (60.3%) were female, and 44% were younger than 12 years old. The attendance of interactive sessions by the teams was 50%. The odds ratio (OR) for additional symptom-free day was 1.31 (95%CI 0.61-2.82; p=0.49). For the secondary results, the results were: controlled asthma OR 1.29 (95%CI 0.89-1.87; p=0.18); unscheduled asthma doctor visits OR 0.81 (95%CI 0.60-1.10; p=0.17); and preventive inhaled corticosteroid use OR 1.02 (95%CI 0.71-1.47; p=0.91). Conclusions: Multifaceted distance education in asthma care for primary care providers was not effective to improve patients’ results. Telemedicine needs to deal with significant obstacles in professional education. ClinicalTrials.gov registry: NCT01595971.
Highlights
Asthma is a highly prevalent chronic disease that affects individuals of all ages, representing an important cause of morbidity and, direct and indirect healthcare expenditures.[1,2,3,4,5] The southern region of Brazil, characterized by a humid subtropical climate with well-defined seasons, moderately cold winters and hot summers,[6] presents the highest prevalence of diagnosis for this condition, estimated at 5.3% of adults.[7]
The objective of the present study was to evaluate the clinical effectiveness of a multifaceted asthma distance education for primary care providers
The objective of the present study was to evaluate the clinical effectiveness of a multifaceted asthma distance education for primary care providers who are members of the Family Health Strategy[24,25] (Box 1) in Rio Grande do Sul, the southernmost state in Brazil
Summary
Asthma is a highly prevalent chronic disease that affects individuals of all ages, representing an important cause of morbidity and, direct and indirect healthcare expenditures.[1,2,3,4,5] The southern region of Brazil, characterized by a humid subtropical climate with well-defined seasons, moderately cold winters and hot summers,[6] presents the highest prevalence of diagnosis for this condition, estimated at 5.3% of adults.[7] Among elementary school students, the prevalence of clinical symptoms has been estimated at 23.6%.8. 30 to 43% report having experienced an exacerbation in the previous year and up to 16% live with important physical limitations caused by the disease.[7] Factors associated with reduced control of asthma symptoms include the underreporting of uncontrolled asthma, underuse of recommended maintenance treatments, and lack of patient information about the disease.[9]. Standard care procedures for patients with asthma are well established in internationally recognized clinical practice guidelines,[1] the mere dissemination of systematized recommendations has been insufficient to improve the care process or clinical results.[10,11,12,13] Strategies involving organizational changes and educational interventions have been evaluated as potential alternatives to those currently used as part of an effort to improve the care provided to patients with chronic diseases.[13,14,15,16,17,18] Reviews of interventions for changing professional practice have demonstrated the positive effects of combined educational strategies on care practices and clinical results.[10,11,12]
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