Implementation of ‘matrix support’ (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil: a pilot observational study

• Published in: NPJ primary care respiratory medicine Vol. 26; no. 1; p. 16047
• Main Authors: Martins, Sonia Maria, Salibe-Filho, William, Tonioli, Luís Paulo, Pfingesten, Luís Eduardo, Braz, Patrícia Dias, McDonnell, Juliet, Williams, Siân, do Carmo, Débora, de Sousa, Jaime Correia, Pinnock, Hilary, Stelmach, Rafael
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 18-08-2016; Nature Publishing Group
• Subjects: 692/699/1785; 692/700/478; Asthma - therapy; Brazil; Education; Education, Medical, Continuing - methods; Humans; Internal Medicine; Medicine; Medicine & Public Health; Patient Care Team - organization & administration; Pilot Projects; Pneumology/Respiratory System; Primary Care Medicine; Primary Health Care; Pulmonary Disease, Chronic Obstructive - therapy; Quality Improvement; Referral and Consultation - statistics & numerical data; Thoracic Surgery
• DOI: 10.1038/npjpcrm.2016.47
• EISSN: 2055-1010

Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of hospitalisation and death in the city of Sao Bernardo do Campo. The municipality had difficulties in sustaining a pulmonology specialist team. Local policy has strengthened the knowledge of the primary care teams to improve the management of these diseases. Our aim is to pilot the implementation of an educational intervention based on collaborative care focused on reducing respiratory-related referrals. We implemented ‘matrix support’: a Brazilian collaborative educational intervention promoting specialist training and support for primary care physicians in three health territories with the highest number of referrals. Clinicians and nurses from primary care attended an 8-h workshop. The backlog of respiratory referrals was prioritised, where Asthma and COPD represented 70% of referral reasons. Initially, pulmonologists held joint consultations with physicians and nurses; as confidence grew, these were replaced by round-table note-based case discussions. The primary outcome was the number of asthma and COPD referrals. Almost all primary healthcare professionals in the three areas (132 of 157–87%) were trained; 360 patients were discussed, including 220 joint consultations. The number of respiratory referrals dropped from 290 (the year before matrix support) to 134 (the year after) (
P
<0.05). Referrals for asthma/COPD decreased from 13.4 to 5.4 cases per month (
P
=0.09) and for other lung diseases from 10.8 to 5.3 cases per month (
P
<0.05). Knowledge scores showed a significant improvement (
P
<0.001). Matrix-support collaborative care was well-accepted by primary care professionals associated with improved knowledge and reduced respiratory referrals. The initiative attracted specialists to the region overcoming historical recruitment problems.
Lung disease management: Collaborative care
Collaborative care could improve management of asthma and chronic obstructive pulmonary disease (COPD). To maximize resources available for asthma and COPD care, Sonia Martins, Rafael Stelmach and colleagues, of the Respiratory Group of Brazilian Society of Family Medicine and Community and University of São Paulo in Brazil, implemented a collaborative care model in three of the nine health territories in the city of São Bernardo do Campo in southeastern Brazil. Family doctors, nurses and healthcare managers attended an eight-hour workshop led by three pulmonologists and one primary care physician to raise professional awareness of the two conditions. Primary care physicians then conducted joint consultations with pulmonologists on patients, followed by individual case discussions without patients. The approach was effective in improving the knowledge and confidence of primary care professionals in managing asthma and COPD. It also decreased the number of referrals to specialists.