Preview

PULMONOLOGIYA

Advanced search

Management of asthma patients in primary care settings: effect of a physician's training

https://doi.org/10.18093/0869-0189-2007-0-5-24-28

Abstract

A cross-sectional analysis of management of asthma patients before and after short-term training of 78 physicians in Bishkek was performed. At baseline, diagnosis of asthma was made in 37 patients (4.1 % of all respiratory diseases). Just after training, in 1 year and in 2 years, asthma was diagnosed in 26, 45 and 26 patients, respectively. At baseline, peak flow measurement and spirometry were not used at all and treatment was mainly symptomatic. The training resulted in improvement of theoretical knowledge score from 84.6 % to 73.3 %; p < 0.001. Use of peak flow measurements increased to 38.5 %, 51.1 % and 38.5 % just after the training, in 1 and 2 years, respectively. Use of spirometry grew to 11.5 %, 17.8 % and 26.9 %, respectively. Inhaled corticosteroids (ICS) were administered to 42.3 %, 53.3 %, and 46.2 %, respectively, vs. 5.4 % at baseline with simultaneous reduction in inadequate administrations of vitamins, antibiotics and expectorants. So, the short-term training was effective. However, application of peak flow measurement in 100 % of the patients should be achieved; the majority of patients need ICS. Ways to increase the training efficiency are necessary.

About the Authors

N. N. Brimkulov
Кыргызско-российский славянский университет; Общественное объединение "Легочное здоровье"
Russian Federation


D. V. Vinnikov
Общественное объединение "Легочное здоровье"
Russian Federation


E. V. Ryzhkova
Кыргызско-российский славянский университет
Russian Federation


References

1. Van Ganse E., Laforest L., Pietri G. et al. Persistent asthma: disease control, resource utilisation and direct costs. Eur. Respir. J. 2002; 20: 260–267.

2. Gendo K., Lodewick M.J. Asthma economics: focusing on therapies that improve costly or outcomes. Curr. Opin. Pulm. Med. 2005; 11: 43–50.

3. Rabe K.F., Adachi M., Lai C.K. et al. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J. Allergy Clin. Immunol. 2004; 114: 40–47.

4. Бримкулов Н.Н. Пульмонология в Кыргызстане: проблемы и перспективы. Вестн. Ассоц. пульмонол. Центр. Азии 2005; 8: 8–17.

5. Global initiative for asthma. Global strategy for asthma management and prevention NHBI/WHJ workshop report. NHLBI Publ. No/95-3659.

6. Gupta R., Anderson H.R., Strachan D.P. et al. International trends in admissions and drug sales for asthma. IJTLD 2006; 10: 138–145.

7. Бримкулов Н.Н. (ред.) Руководство по ведению больных с болезнями органов дыхания для врачей первичного уровня здравоохранения на основе стратегии PAL ВОЗ. Бишкек: Илим; 2005.

8. Davis D., Evans M., Jadad A. et al. The case for knowledge translation: shortening the journey from evidence to effect. Br. Med. J. 2003; 327: 33–35.

9. Philips J.J., Stone R.D. How to measure training results. A practical guide to tracking the six key indicators. New York: McGraw Hill; 2002.

10. Mannino D.M., Gagnon R.C., Petty T.L., Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988–1994. Arch. Intern. Med. 2000; 118 (4): 981–989.

11. Thiadens H.A., De Bock G.H., Van Houwelingen J.C. et al. Can peak expiratory flow measurements reliably identify the presence of airway obstruction and bronchodilator response as assessed by FEV 1 in primary care patients presenting with a persistent cough? Thorax 1999; 54: 1055–1060.

12. Ait!Khaled N., Enarson D.A., Bencharif N. et al. Implementation of asthma guidelines in health centres of several developing countries. Int. J. Tuberc. Lung Dis. 2006; 10: 104–109.

13. Rastogi D., Shetty A., Neugebauer R. et al. National Heart, Lung, and Blood Institute guidelines and asthma management practices among inner-city pediatric primary care providers. Chest 2006; 129: 619–623.

14. Laforest L., Van Ganse E., Devouassoux G. Management of asthma in patients supervised by primary care physicians or by specialists. Eur. Respir. J. 2006; 27: 42–50.

15. Kavuru M., Melamed J., Gross G. et al. Salmeterol and fluticasone propionate combined in a new powder inhalation device for the treatment of asthma: a randomized, doubleblind, placebo-controlled trial. J. Allergy Clin. Immunol. 2000; 105: 1108–1116.

16. Krishnan J.A., Riekert K.A., McCoy J.V. et al. Corticosteroid use after hospital discharge among high-risk adults with asthma. Am. J. Respir. Crit. Care Med. 2004; 170 (12): 1281–1285.

17. Williams L.K., Pladevall M., Xi H. et al. Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma. J. Allergy Clin. Immunol. 2004; 114: 1288–1293.

18. Fairall L.R., Zwarenstein M., Bateman E.D. et al. Effect of educational outreach to nurses on tuberculosis case detection and primary care of respiratory illness: pragmatic cluster randomized controlled trial. Brit. Med. J. 2005; 331: 750–754.


Review

For citations:


Brimkulov N.N., Vinnikov D.V., Ryzhkova E.V. Management of asthma patients in primary care settings: effect of a physician's training. PULMONOLOGIYA. 2007;(5):24-28. (In Russ.) https://doi.org/10.18093/0869-0189-2007-0-5-24-28

Views: 292


ISSN 0869-0189 (Print)
ISSN 2541-9617 (Online)