PAL feasibility test results in the setting of primary health care in Macedonia

Abstract

Introduction: PAL (practical approach to lung health) trainings in the setting of PHC (primary health care) was started in Macedonia at 2013 with the aim to improve the management quality of patients with respiratory symptoms. Aim of the study: was to present the efficacy of PAL education among the GPs (general practitioners) in the standard case management of respiratory conditions in patients aged > or =5 years. Methods: The first phase of PAL education engaged 84 doctors from PHC. Education covers the most frequent respiratory conditions. In order to conduct evaluation upon the efficiency of doctors9 education from PHC, GPs fill in a form out of 69 questions before (baseline survey) and after PAL training (impact survey) and the results of two surveys were compared. Results: The baseline survey registered 5979 respiratory patients and the impact survey 7125. As a result of training, referrals to a higher level of the patients with pneumonia decreased by 4 % and the number of antibiotics prescribed per patients decreased from 1,3 to 0,9. There was an increase of patients with COPD managed in the PHC settings by 7,3%. Training of PAL increased the prescription of inhaled medications by 8% and the usage of peak flow meter by 13% among the patients with asthma. The proportion of tuberculosis suspects identified increased only by 2%. Conclusions: even the first results of PAL training are very modest showing quality improve in the treatment of respiratory diseases at PHC settings. We should continue with PAL education at PHC settings with the aim to enhance the competency of GPs through the use of evidence-based clinical guidelines and cost saving accrue from reduction of inappropriate drug prescription.