ArticleBMJ global health2019
Effects of PACK guide training on the management of asthma and chronic obstructive pulmonary disease by primary care clinicians: a pragmatic cluster randomised controlled trial in Florianópolis, Brazil.
Article in BMJ global health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02786030 (Integrated Primary Care for Chronic Lung Diseases in Less Developed Countries), which is not on this map. Cited by 15 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Integrated Primary Care for Chronic Lung Diseases in Less Developed Countries: Pragmatic Trial of the Practical Approach to Care Kit in Brazil (PACK Brazil)
Who cites it
15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 21 citations in OpenAlex.
- Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care.The Cochrane database of systematic reviews · 2022Pooled it
- Integrated disease management interventions for patients with chronic obstructive pulmonary disease.The Cochrane database of systematic reviews · 2021Pooled it
- Strategies to improve smoking cessation rates in primary care.The Cochrane database of systematic reviews · 2021Pooled it
- Trial
- From face-to-face to e-learning: transitioning to new training models to strengthen the health system by supporting primary healthcare workers in low- and middle-income countries.BMJ global health · 2026Article
- Addressing health information inequities: making evidence-based clinical content more accessible in low- and middle-income primary care.BMJ global health · 2025Article
- Extending a parallel cluster randomised trial into a stepped-wedge cluster randomised trial: implications for interpretation.BMJ global health · 2025Article
- Ethiopian primary healthcare clinical guidelines 5 years on-processes and lessons learnt from scaling up a primary healthcare initiative.BMJ global health · 2024Article
- Clinically sound and person centred: streamlining clinical decision support guidance for multiple long-term condition care.BMJ global health · 2024Article
- Supporting a rapid primary care response to emergent communicable disease threats with PACK (Practical Approach to Care Kit) in Florianópolis, Brazil.BMJ global health · 2024Article
- Barriers and enablers to improving integrated primary healthcare for non-communicable diseases and mental health conditions in Ethiopia: a mixed methods study.BMC primary care · 2024Article
- The Roles of Electronic Health Records for Clinical Trials in Low- and Middle-Income Countries: Scoping Review.JMIR medical informatics · 2023Article
- Understanding and controlling asthma in Latin America: A review of recent research informed by the SCAALA programme.Clinical and translational allergy · 2023Review
- Asthma management in low and middle income countries: case for change.The European respiratory journal · 2022Review
- ERS/EAACI statement on adherence to international adult asthma guidelines.European respiratory review : an official journal of the European Respiratory Society · 2021Article
Corrections and comments
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Authors and funding
14 authors at 8 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe Practical Approach to Care Kit (PACK) guide was localised for Brazil, where primary care doctors and nurses were trained to use it.
methodsTwenty-four municipal clinics in Florianópolis were randomly allocated to receive outreach training and the guide, and 24 were allocated to receive only the guide. 6666 adult patients with asthma or chronic obstructive pulmonary disease (COPD) were enrolled, and trial outcomes were measured over 12 months, using electronic medical records. The primary outcomes were composite scores of treatment changes and spirometry, and new asthma and COPD diagnosis rates.
resultsAsthma scores in 2437 intervention group participants were higher (74.8%, 20.4% and 4.8% with scores of 0, 1 and 2, respectively) than in 2633 control group participants (80.0%, 16.8% and 3.2%) (OR for higher score 1.32, 95% CI 1.08 to 1.61, p=0.006). Adjusted for asthma scores recorded in each clinic before training started, the OR was 1.24 (95% CI 1.03 to 1.50, p=0.022). COPD scores in 1371 intervention group participants (77.7%, 17.9% and 4.3% with scores of 0, 1 and 2) did not differ from those in 1181 control group participants (80.5%, 15.8% and 3.7%) (OR 1.21, 95% CI 0.94 to 1.55, p=0.142). Rates of new asthma and COPD diagnoses, and hospital admission, and indicators of investigation, diagnosis and treatment of comorbid cardiovascular disease, diabetes and depression, and tobacco cessation did not differ between trial arms.
conclusionPACK training increased guideline-based treatment and spirometry for asthma but did not affect COPD or comorbid conditions, or diagnosis rates.
trial registrationNCT02786030 (https://clinicaltrials.gov/).
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