Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Jul;10(7):4667-4677.
doi: 10.21037/jtd.2018.07.34.

Integrating primary care of chronic respiratory disease, cardiovascular disease and diabetes in Brazil: Practical Approach to Care Kit (PACK Brazil): study protocol for randomised controlled trials

Max O Bachmann  1 , Eric D Bateman  2 , Rafael Stelmach  3 , Álvaro A Cruz  4 , Matheus Pacheco de Andrade  5 , Ronaldo Zonta  5 , Jorge Zepeda  6 , Sonia Natal  7 , Ruth Cornick  2 , Camilla Wattrus  2 , Lauren Anderson  2 , Carl Lombard  8 , Lara R Fairall  2
Affiliations
Review

Integrating primary care of chronic respiratory disease, cardiovascular disease and diabetes in Brazil: Practical Approach to Care Kit (PACK Brazil): study protocol for randomised controlled trials

Max O Bachmann et al. J Thorac Dis. 2018 Jul.

Abstract

Background: Multimorbidity is increasing common in Brazilian adults. Comorbid chronic lung disease, cardiovascular disease and diabetes are often inaccurately diagnosed or ineffectively treated. The Global Alliance against Chronic Respiratory Diseases (GARD) aims to strengthen health systems to prevent and control non-communicable diseases through primary health care. The Practical Approach to Care Kit (PACK Adult) is a clinical decision support tool that provides evidence-supported algorithmic guidelines for screening, diagnosis and treatment of chronic diseases, and is widely used in South Africa. It was adapted for Brazil by family physicians in the Florianopolis City Health Department, which trains clinic doctors and nurses to use it.

Methods: Effectiveness of PACK Adult training will be evaluated in two pragmatic cluster randomised trials, one enrolling adults with chronic lower respiratory diseases and the other enrolling adults with cardiovascular disease or diabetes. Forty-eight municipal clinics in Florianopolis were randomly allocated to intervention or control arms. In intervention arm clinics, doctors and nurses will receive educational outreach training and the PACK Adult clinical decision support tool. In control arm clinics, doctors and nurses will receive only the tool. Trial outcomes will be measured using patients' electronic medical records during 12 months after completion of basic training. Primary outcomes for the respiratory trial are appropriate prescribing, spirometry and diagnosis rates. Primary outcomes for the cardiovascular trial are testing for cardiovascular risk and diabetes, and systolic blood pressure. Educational outreach to primary care professionals could improve respiratory, cardiovascular and diabetes care in Brazil.

Trial registration: NCT02786030 and NCT02795910 (https://clinicaltrials.gov/).

Keywords: Primary health care; asthma; cardiovascular disease (CVD); chronic obstructive pulmonary disease (COPD); diabetes; randomised controlled trial (RCT).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The Florianopolis City Health Department has a non-financial interest, and the KTU and BMJ Publishing have a financial interest, in the intervention being shown to be effective. The KTU and BMJ Publishing have entered into a non-profit partnership to explore ways of making annual revisions of the PACK CDST and associated materials globally available, and to provide mentorship support to in-country teams wishing to localise it for their settings. The authors declare that they have no other competing interests.

Figures

Figure 1
Figure 1
Study design and activities over time.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Schmidt MI, Duncan BB, Silva GA, et al. Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet 2011;377:1949-61. 10.1016/S0140-6736(11)60135-9 - DOI - PubMed
    1. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1151-210. 10.1016/S0140-6736(17)32152-9 - DOI - PMC - PubMed
    1. Khaltaev N. GARD, a new way to battle with chronic respiratory diseases, from disease oriented programmes to global partnership. J Thorac Dis 2017;9:4676-89. 10.21037/jtd.2017.11.91 - DOI - PMC - PubMed
    1. Cruz AA, Camargos PA, Urrutia-Pereira M, et al. Global Alliance against Chronic Respiratory Diseases (GARD) Brazil success case: overcoming barriers. J Thorac Dis 2018;10:534-8. 10.21037/jtd.2018.01.40 - DOI - PMC - PubMed
    1. Rzewuska M, de Azevedo-Marques JM, Coxon D, et al. Epidemiology of multimorbidity within the Brazilian adult general population: Evidence from the 2013 National Health Survey (PNS 2013). PLoS One 2017;12:e0171813. 10.1371/journal.pone.0171813 - DOI - PMC - PubMed

Associated data

LinkOut - more resources