Distance Education to Improve the Quality of Asthma Treatment in Primary Health Care: Cluster Randomized Clinical Trial - RESPIRANET

Rudi Roman; Karine Margarites Lima; Maria Angela Fontoura Moreira; Roberto Nunes Umpierre; Lisiane Hauser; Dimitris V Rados; Alvaro Vigo; Marcelo Rodrigues Gonçalves; Sotero Serrate Mengue; Erno Harzheim

doi:10.5712/rbmfc14(41)2065

Authors

Rudi Roman Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul http://orcid.org/0000-0002-2663-4314
Karine Margarites Lima Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul
Maria Angela Fontoura Moreira Serviço de Pneumologia do Hospital de Clínicas de Porto Alegre http://orcid.org/0000-0002-9258-1054
Roberto Nunes Umpierre Faculdade de Medicina da Universidade Federal do Rio Grande do Sul e Núcleo de Telessaúde da Universidade Federal do Rio Grande do Sul | TelessaúdeRS-UFRGS http://orcid.org/0000-0001-9841-5543
Lisiane Hauser Ministério da Saúde http://orcid.org/0000-0003-3324-5533
Dimitris V Rados Núcleo de Telessaúde da Universidade Federal do Rio Grande do Sul http://orcid.org/0000-0003-0819-5343
Alvaro Vigo Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul http://orcid.org/0000-0002-5797-9470
Marcelo Rodrigues Gonçalves Faculdade de Medicina da Universidade Federal do Rio Grande do Sul e Núcleo de Telessaúde da Universidade Federal do Rio Grande do Sul | TelessaúdeRS-UFRGS http://orcid.org/0000-0001-8516-8547
Sotero Serrate Mengue Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul http://orcid.org/0000-0002-3349-8541
Erno Harzheim Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul http://orcid.org/0000-0002-8919-7916

DOI:

https://doi.org/10.5712/rbmfc14(41)2065

Keywords:

Asthma, Education, Distance, Family Practice, Primary Health Care, Telemedicine, Clinical Trial

Abstract

Objective: The mere dissemination of standard care recommendations has been insufficient to improve clinical results in patients with asthma. The objective of the present study was to evaluate the clinical effectiveness of a multifaceted asthma distance education for primary care providers. Methods: Cluster randomized controlled trial. Full primary care teams were included if they had access to telehealth support and free basic asthma treatment. Before randomization, selected teams indicated asthma patients between 5-45 years old for inclusion. The intervention group received three interactive online sessions, printed educational material, reminders, booklet for patients, and frequent stimulus to use consulting services. The control group received no intervention. Symptomfree days per two weeks was the primary result. Controlled asthma, unscheduled asthma doctor visits, and preventive inhaled corticosteroid use were the secondary results. Six months after intervention, the results were compared with baseline data using generalized estimating equations for repeated measures and clustering effect. Results: Were enrolled 71 primary care teams and 443 individuals. Most patients (60.3%) were female, and 44% were younger than 12 years old. The attendance of interactive sessions by the teams was 50%. The odds ratio (OR) for additional symptom-free day was 1.31 (95%CI 0.61-2.82; p=0.49). For the secondary results, the results were: controlled asthma OR 1.29 (95%CI 0.89-1.87; p=0.18); unscheduled asthma doctor visits OR 0.81 (95%CI 0.60-1.10; p=0.17); and preventive inhaled corticosteroid use OR 1.02 (95%CI 0.71-1.47; p=0.91). Conclusions: Multifaceted distance education in asthma care for primary care providers was not effective to improve patients’ results. Telemedicine needs to deal with significant obstacles in professional education. ClinicalTrials.gov registry: NCT01595971.

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Author Biography

Rudi Roman, Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul

Possui graduação em Medicina pela Pontifícia Universidade Católica do Rio Grande do Sul (2006). Completou residência médica em Medicina de Família e Comunidade (MFC) no Grupo Hospitalar Conceição (GHC) em Porto Alegre RS (2010). Mestre e doutorando em Epidemiologia pela UFRGS (2017). É coordenador da equipe de Teleconsultoria e Regulação do TelessaúdeRS-UFRGS, projeto que tem como objetivo melhorar a qualidade do atendimento da Atenção Primária à Saúde do Sistema Único de Saúde (SUS) através da Telemedicina.

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