Distance Education to Improve the Quality of Asthma Treatment in Primary Health Care: Cluster Randomized Clinical Trial - RESPIRANET / Educação a distância para melhorar a qualidade do tratamento da asma na Atenção Primária à Saúde: ensaio clínico randomizado em cluster - RESPIRANET / Educación a distancia para mejorar la calidad del tratamiento del asma en la atención primaria de salud: ensayo clínico aleatorizado grupal - RESPIRANET

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.

Objetivo: A mera disseminação de recomendações de cuidados padronizados tem sido insuficiente para melhorar os desfechos clínicos em pacientes com asma. O objetivo do presente estudo foi avaliar a eficácia clínica de uma intervenção educativa multifacetada a distância sobre asma para profissionais da atenção primária à saúde. Métodos: Ensaio clínico randomizado por cluster. Equipes completas de atenção primária foram incluídas se tinham acesso a suporte de telessaúde e tratamento básico gratuito para asma. Antes da randomização, as equipes selecionadas indicaram pacientes asmáticos entre 5-45 anos para inclusão. O grupo de intervenção recebeu três sessões online interativas, material educativo impresso, lembretes, folheto para pacientes e estímulos frequentes para o uso de serviços de consultoria. O grupo controle não recebeu intervenção. O desfecho primário foi dias sem sintomas por duas semanas. Asma controlada, consultas médicas não programadas para asma e uso preventivo de corticosteroides inalatórios foram os desfechos secundários. Seis meses após a intervenção, os resultados foram comparados com a linha de base, usando equações de estimativas generalizadas para medidas repetidas e efeito de agrupamento. Resultados: Foram inscritas 71 equipes de atenção primária e 443 indivíduos. A maioria dos pacientes (60,3%) era do sexo feminino e 44% tinha menos de 12 anos de idade. A frequência das equipes nas sessões interativas foi de 50%. O odds ratio (OR) para dias sem sintomas adicionais foi de 1,31 (IC 95% 0,61-2,82; p=0,49). Para os desfechos secundários, os resultados foram: asma controlada 1,29 (IC 95% 0,89-1,87; p=0,18); visitas não programadas de asma ao médico OR 0,81 (IC 95% 0,60-1,10; p=0,17); e uso preventivo de corticosteroides inalatórios OR 1,02 (IC 95% 0,71-1,47; p=0,91). Conclusões: Ações multifacetadas de educação a distância em cuidados de asma para profissionais de saúde da atenção primária não foram eficazes para melhorar os resultados nos pacientes. A telemedicina precisa lidar com obstáculos significativos na educação profissional. Registro ClinicalTrials.gov: NCT01595971.

Objetivo: La mera difusión de las recomendaciones de atención estándar ha sido insuficiente para mejorar los resultados clínicos en pacientes con asma. El objetivo del presente estudio fue evaluar la efectividad clínica de una educación multifacética a distancia sobre el asma para los proveedores de atención primaria. Métodos: Ensayo controlado aleatorizado por grupos. Se incluyeron equipos completos de atención primaria si tenían acceso a apoyo de telesalud y tratamiento básico gratuito para el asma. Antes de la aleatorización, los equipos seleccionados indicaron pacientes con asma entre 5-45 años de edad para inclusión. El grupo de intervención recibió tres sesiones interactivas en línea, material educativo impreso, recordatorios, folleto para los pacientes y estímulos frecuentes para utilizar los servicios de consultoría. El grupo control no recibió ninguna intervención. El resultado primario fue días sin síntomas por dos semanas. Los resultados secundarios fueron asma controlada, visitas médicas no programadas para el asma y el uso preventivo de corticosteroides inhalados. Seis meses después de la intervención, los resultados se compararon con los datos de referencia utilizando ecuaciones de estimación generalizadas para medidas repetidas y efecto de agrupación. Resultados: Se inscribieron 71 equipos de atención primaria y 443 personas. La mayoría de los pacientes (60,3%) eran mujeres y el 44% eran menores de 12 años. La asistencia a sesiones interactivas por parte de los equipos fue del 50%. La razón de probabilidades (OR) para un día sin síntomas adicional fue de 1.31 (IC del 95%: 0.61 a 2.82; p=0.49). Para los resultados secundarios, los resultados fueron: asma controlada O 1.29 (IC del 95%: 0.89 a 1.87; p=0.18); visitas al médico para el asma no programadas O 0,81 (IC del 95%: 0,60 a 1,10; p=0,17); y el uso preventivo de corticosteroides inhalados OR 1.02 (IC del 95%: 0.71 a 1.47; p=0.91). Conclusiones: La educación a distancia multifacética en el cuidado del asma para los proveedores de atención primaria no fue efectiva para mejorar los resultados de los pacientes. La telemedicina debe enfrentar obstáculos significativos en la educación profesional. Registro de ClinicalTrials.gov: NCT01595971.

Airway Diseases Education and Expertise (ADEX ) in Pediatrics: Adaptation for Clinical Practice in India.

Justification: Asthma and allergic rhinitis together are part of the concept of ‘one airway, one disease’ or ‘united airway disease’. The management of allergic airway diseases should address this united concept and manage the issue by educating the patients and their parents and health care providers, along with environmental control measures, pharmacotherapy and immunotherapy. Here, we present recommendations from the module of ‘Airway Diseases Education and Expertise’ (ADEX) that focused on allergic rhinitis, asthma and sleep disorder breathing as a single entity or Allergic Airway Disease. Process: A working committee was formed by the collaboration of Pediatric Allergy Association of India (PAAI) and Indian Academy of Pediatrics (IAP) Allergy and Applied Immunology chapter to develop a training module on united airway disease. Objectives: To increase awareness, understanding and acceptance of the concept of "United Airway disease" and to educate the primary health care providers for children and public health officials, in the management of united airway diseases. Recommendations: Recommendations for diagnosis, management and follow-up of Allergic airway disease are presented in this document. A better compliance by linking education of child, parent, grandparents and other health care providers, and scientific progress by collaboration between practitioners, academicians, researchers and pharmaceutical companies is suggested.

Educación en niños asmáticos controlados en hospital Roberto del Río: impacto en conocimientos, adherencia y control de la enfermedad / Education in asthmatic children controlled at Roberto del Rio Hospital. Impact on knowledge, adhesion and disease control

Introduction: today is clear the role of educational programs in the control of chronic diseases. The goal was optimize the knowledge, adhesion, inhalation technique and asthma control through an educational workshop. Methods: we enrolled asthmatic patients (age 5 to 14 years), with questionnaire "control of asthma in children " (CAN). Patients with an score greater than or equal to 8 were invited to the educational workshop with a class of asthma, after a evaluation of knowledge and inhalation technique. These patients were reevaluated 6 months later. Results: 91 patients were recruited with a CAN score greater than or equal to 8, only 49 attended the workshop and 40 attended the reevaluation. Of these, 52,5 percent of the patients achieved a CAN score less than 8. Two patients were excluded because of modification of treatment, resulting in 47,5 percent of patients with CAN score less than 8. Conclusion: the education improved the knowledge, inhalation technique and adherence. Educational workshop should be implemented in our clinical practice.

Introducción: el objetivo fue optimizar los conocimientos, técnica inhalatoria, adherencia y el control del asma, mediante un taller de educación. Métodos: se enrolaron pacientes asmáticos (edad: entre 5 y 14 años), con cuestionario CAN (Control del Asma en Niños). Los pacientes con puntaje mayor o igual a 8, se invitaron a un taller de educación, se evaluó conocimientos, técnica inhalatoria y se realizó una clase sobre asma. A los 6 meses, se reevaluaron con cuestionario CAN, prueba de conocimientos y técnica inhalatoria. Resultados: se reclutaron 91 pacientes con CAN mayor o igual a 8, de los cuales asistieron 49 al taller. En la segunda etapa asistieron 40 pacientes. En el 52,5 por ciento de los pacientes, se logró puntaje CAN menor a 8 puntos. Se excluyeron 2 pacientes, por modificación del tratamiento, como resultado final 47,5 por ciento de los pacientes, disminuyó su puntaje CAN a menos de 8. Conclusiones: la educación mejoró conocimientos, técnica inhalatoria y adherencia. Se deberían implementar talleres educativos en nuestra práctica clínica.