University and public health system partnership: A real-life intervention to improve asthma management

ABSTRACT

Objective: Asthma is under-diagnosed in many parts of the world. We aimed to assess the outcome of a capacitating program on asthma for non-specialist physicians and other healthcare professionals working in the public system in Ribeirão Preto, Brazil. Methods: A group of 16 asthma specialists developed a one-year capacitating program in 11 healthcare clinics in the Northern District of the city, which included lectures on asthma, training on inhalation device use and spirometry, and development of an asthma management protocol. Researchers visited one health unit 2–4 times monthly, working with doctors on patients' care, discussing cases, and delivering lectures. Asthma education was also directed to the general population, focusing on recognition of signs and symptoms and long-term treatment, including production of educational videos available on YouTube. Outcome measures were the records of doctors' prescriptions of individual asthma medications pre- and post-intervention. Results: Prior to the program, 3205 units of inhaled albuterol and 2876 units of inhaled beclomethasone were delivered by the Northern District pharmacy. After the one-year program, there was increase to 4850 units (51.3%) for inhaled albuterol and 3526 units (22.6%) for inhaled beclomethasone. The albuterol increase followed the recommendation given to the non-specialist doctors by the asthma experts, that every patient with asthma should have inhaled albuterol as a rescue medication, by protocol. No increase was observed in other districts where no capacitating program was conducted. Conclusion: A systematic capacitating program was successful in changing asthma prescription profiles among non-specialist doctors, with increased delivery of inhaled albuterol and beclomethasone.

KEYWORDS:

• Asthma
• wheezing
• professional education
• diagnosis
• regional medical programs

Acknowledgments

We thank Stênio J. C. Miranda, MD, Secretary of Health of the City of Ribeirão Preto, and the administrative and technical personnel of the Health Secretariat, particularly Mrs. Darlene C. P. Mestriner, PharmD, Maria Dolores Biasoli, MD, Magali A. Perez, DDS, and Elen A. Macedo Jr, DDS, for the support, allowing the present study to be carried out at the Healthcare Units of the Northern District of the city. We appreciate the help of the Pharmacists Cláudia S. Vassimon, PhD, Lúcia Helena T. Rodrigues, PhD and Rute A. C. Garcia, PhD, from the Pharmacy Department, with issues regarding dispensation of asthma medications; and the assistance of Mrs. Mirela P. Lourenço, from the Informatics Department, with acquisition of bioinformatics data. We are grateful to the collaborative efforts of the physicians and other healthcare professionals of the Healthcare Units of the Northern District to participate in the capacitating program. We are also grateful to Mrs. Elisabete Sobrani, spirometry technician of the Pulmonary Division of the Clinical Hospital of Ribeirão Preto Medical School, for assistance with spirometry.

Declaration of interest

The authors have no conflict of interests to declare. The authors alone are responsible for the content and writing of this article.

Funding

This study was supported by the Foundation for Research Support of the State of São Paulo and Brazilian National Health System (FAPESP/SUS, PPSUS Program) project number 2009/53225-4, and Institute of Investigation in Immunology iii-INCT.