Reorganization of respiratory health care: collaborative care actions of primary and secondary care to reduce referrals to public health system

05 Aug 2021
Type of resource
Dublin 2021
Mariah Taube, InCor - Instituto do Coração HCFMUSP, Brazil
Clinical Research Results Implementation Science/Service Development Aim: Reorganization of respiratory health care: collaborative care actions of primary and secondary care to reduce referrals to public health system Brief outline of context: Chronic Respiratory diseases (CRD) have high rates of prevalence, morbidity and mortality in Brazil and worldwide. Moreover, almost 70% of Brazilian population relies on public health system. Specialist assistance is scarce with huge demand difficult access. Despite of free of charge medication treatments, hundred thousand patients die every day, and mortality rate remains unchanged over the years. Brief description of the intervention and why thought it would work: To achieve quality and resolution diagnosis and treatment to CRD in primary health care (PHC) in a medium-sized Brazilian city (168,000 inh.) The primary outcome was a reduction of referrals to the pulmonology clinic, and second an increase in dispensation of inhaled medications to usual treatment to CRD. Structured intervention in PHC brought specialized with emphasis on collaborative care in pulmonology, in addition to referencing and permanent education. Strategy for change: The project had 3 phases, and had beginning in September 2017: First phase: Training 100% of the staff in PHC, with classes and didactic material. Second phase: Shared care where the pulmonologist in joint didactic way with the general staff, consulted previously selected cases in each health unit. Third phase: referral of mild cases from the pulmonology clinic back to PHC. After 2 years of intervention, there was a 29% reduction in medical consultations for patients classified as having mild disease (p = 0,015) (table 1). In addition, after first phase, there was a significant 59% increase in the prescription of inhaled corticosteroids (table 2). Conclusions: Collaborative care has been proposed in other specialties, in different regions of the world, with positive results. Brazilian clinical protocols focusing Primary Health Care, have confirmed success in reducing hospitalizations and decreasing direct and indirect costs. The tenuous limit of primary and secondary care needs to enhanced to allow continuous advances in the construction of more integrated and efficient systems.References:, S., Salibe-Filho, W., Tonioli, L. et al.Implementation of ‘matrix support’ (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil: a pilot observational study. npj Prim Care Resp Med 26, 16047 (2016). AA. Camargos PA, Urrutia-Pereira M, Stelmach R. Global Alliance against Chronic Respiratory Diseases (GARD) Brazil success case: overcoming barriers. J Thorac Dis 2018;10(1):534-538. doi: 10.21037/jtd.2018.01.40 Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest References and Clinical Trial Registry Information