在巴西弗洛里亚诺波利斯实施 2 年后，初级保健临床医生进行 PACK 培训对哮喘和慢性阻塞性肺疾病管理的影响：采用渐进式整群随机对照试验设计的实用型扩展随访。
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.
机构信息
Norwich Medical School, University of East Anglia, Norwich, UK.
Norfolk and Norwich University Hospital NHS Trust, Norwich, UK.
出版信息
BMJ Glob Health. 2024 Oct 28;9(Suppl 3):e013819. doi: 10.1136/bmjgh-2023-013819.
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.
背景
在之前的一项随机试验中，培训初级保健医生和护士使用实用护理方法工具包（PACK）提高了对哮喘和慢性阻塞性肺疾病（COPD）的管理。本研究检查了培训效果，包括第二年的随访和重复培训课程的扩展覆盖范围。
方法
使用阶梯式楔形集群随机试验设计，将 48 个诊所随机分配到序列 A：（1）无干预，（2）无干预，（3）干预或序列 B：（1）无干预，（2）干预，（3）干预，为期三个 12 个月的周期。主要结果是治疗和肺功能测定结果的变化。使用混合效应逻辑回归模型估计任何培训暴露的效果，以及第一年和第二年培训的暴露效果。
结果
任何培训暴露都与哮喘患者治疗变化增加（调整日历时间的比值比（OR）1.29，95%CI 1.02 至 1.64）和更多的肺功能测定结果有关，并且 COPD 患者的肺功能测定结果更多（OR 1.55，（95%CI 1.22 至 1.97））。与无暴露相比，在接触培训的第一年和第二年，哮喘患者的治疗变化更有可能发生（ORs 1.43（95%CI 1.09 至 1.87）；1.91（95%CI 1.21 至 3.02））。在哮喘患者（ORs 1.76（95%CI 1.34 至 2.30）；2.05（95%CI 1.32 至 3.19））和 COPD 患者（ORs 1.57（95%CI 1.18 至 2.10））中，在第一年和第二年的接触中，肺功能更有可能发生；1.71（95%CI 1.08 至 2.70））。
结论
延长随访表明，PACK 培训继续有效改善慢性呼吸道护理，有效的干预措施可持续 2 年。
试验注册号
NCT02786030。
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