Fairall Lara R, Zwarenstein Merrick, Bateman Eric D, Bachmann Max, Lombard Carl, Majara Bosielo P, Joubert Gina, English Rene G, Bheekie Angeni, van Rensburg Dingie, Mayers Pat, Peters Annatjie C, Chapman Ronald D
Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Groote Schuur, South Africa.
BMJ. 2005 Oct 1;331(7519):750-4. doi: 10.1136/bmj.331.7519.750.
To develop and implement an educational outreach programme for the integrated case management of priority respiratory diseases (practical approach to lung health in South Africa; PALSA) and to evaluate its effects on respiratory care and detection of tuberculosis among adults attending primary care clinics.
Pragmatic cluster randomised controlled trial, with clinics as the unit of randomisation.
40 primary care clinics, staffed by nurse practitioners, in the Free State province, South Africa.
1999 patients aged 15 or over with cough or difficult breathing (1000 in intervention clinics, 999 in control clinics).
Between two and six educational outreach sessions delivered to nurse practitioners by usual trainers from the health department. The emphasis was on key messages drawn from the customised clinical practice guideline for the outreach programme, with illustrative support materials.
Sputum screening for tuberculosis, tuberculosis case detection, inhaled corticosteroid prescriptions for obstructive lung disease, and antibiotic prescriptions for respiratory tract infections.
All clinics and almost all patients (92.8%, 1856/1999) completed the trial. Although sputum testing for tuberculosis was similar between the groups (22.6% in outreach group v 19.3% in control group; odds ratio 1.22, 95% confidence interval 0.83 to 1.80), the case detection of tuberculosis was higher in the outreach group (6.4% v 3.8%; 1.72, 1.04 to 2.85). Prescriptions for inhaled corticosteroids were also higher (13.7% v 7.7%; 1.90, 1.14 to 3.18) but the number of antibiotic prescriptions was similar (39.7% v 39.4%; 1.01, 0.74 to 1.38).
Combining educational outreach with integrated case management provides a promising model for improving quality of care and control of priority respiratory diseases, without extra staff, in resource poor settings.
Current controlled trials ISRCTN13438073.
制定并实施一项针对重点呼吸道疾病综合病例管理的教育推广计划（南非肺部健康实用方法；PALSA），并评估其对在基层医疗诊所就诊的成年人的呼吸道护理及结核病检测的影响。
实用整群随机对照试验，以诊所作为随机分组单位。
南非自由邦省的40家由执业护士提供服务的基层医疗诊所。
1999名年龄在15岁及以上、有咳嗽或呼吸困难症状的患者（干预组诊所1000名，对照组诊所999名）。
由卫生部门的常规培训人员为执业护士开展两至六次教育推广课程。重点是从针对该推广计划定制的临床实践指南中提取的关键信息，并配有说明性辅助材料。
结核病痰涂片筛查、结核病病例检出率、阻塞性肺病吸入性糖皮质激素处方以及呼吸道感染抗生素处方。
所有诊所及几乎所有患者（92.8%，1856/1999）完成了试验。虽然两组间结核病痰检情况相似（推广组为22.6%，对照组为19.3%；优势比1.22，95%置信区间0.83至1.80），但推广组的结核病病例检出率更高（6.4%对3.8%；1.72，1.04至2.85）。吸入性糖皮质激素处方也更多（13.7%对7.7%；1.90，1.14至3.18），但抗生素处方数量相似（39.7%对
39.4%；1.01，0.74至1.38）。
在资源匮乏地区，将教育推广与综合病例管理相结合为在不增加额外人员的情况下提高护理质量和控制重点呼吸道疾病提供了一个有前景的模式。
当前受控试验ISRCTN13438073 。
