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Review
. 2022 Jul;14(7):2689-2697.
doi: 10.21037/jtd-21-1345.

Practical approach lung health-global alliance against chronic respiratory diseases (PAL-GARD) initiative in Brazil

Bruno Piassi São José  1   2 , Eric Bateman  3 , Cláudia Myriam Amaral Botelho  4 , José Geraldo Félix de Seixas Maciel  5 , Eliane Viana Mancuzo  6 , Paulo A M Camargos  7   8 , Ricardo Amorim Corrêa  9
Affiliations
Review

Practical approach lung health-global alliance against chronic respiratory diseases (PAL-GARD) initiative in Brazil

Bruno Piassi São José et al. J Thorac Dis. 2022 Jul.

Abstract

Background: To evaluate the impact of training primary care physicians (PCPs) in the use of the practical approach lung health-global alliance against chronic respiratory diseases (PAL-GARD) upon their diagnostic skills.

Methods: In this real-life three-phase study, PCPs were allocated to a PAL-GARD training or control group. Patients who sought a primary care health facility due to cough, dyspnea and/or wheezing were eligible. The clinical diagnoses made by PCPs during the baseline and post-intervention phase were audited by a panel of pulmonologists. Kappa inter-rater statistics was used to compare agreement between PCPs and pulmonologists.

Results: Thirty PCPs evaluated 536 patients, 358 in the intervention and 178 in the control group. According to Kappa, there was an increase in the agreement in the diagnosis of asthma (from 0.546 to 0.638), tuberculosis (from 0.393 to 0.655) and acute respiratory infections (ARI) (from 0.577 to 0.584) was observed in the PAL-GARD group, but there was a reduction in chronic obstructive pulmonary disease (COPD) (from 0.430 to 0.284).

Conclusions: In this setting, PAL-GARD-based guide and training improved the clinical diagnosis of common respiratory diseases with the exception of COPD.

Keywords: Respiratory diseases; diagnosis; primary care physicians (PCPs); primary health care (PHC).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-21-1345/coif). The series GARD Section was commissioned by the editorial office without any funding or sponsorship. The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of the allocation of PCPs and patients in the study groups and phases. PCP, primary care physician; PAL-GARD, practical approach lung health-global alliance against chronic respiratory diseases.
See this image and copyright information in PMC

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