Practical Approach to Lung Health – Experience from the Republic of Macedonia

Ilievska Poposka, Biljana and Zakoska, Maja and Talevski, Srefan (2018) Practical Approach to Lung Health – Experience from the Republic of Macedonia. Open Access Macedonian Journal of Medical Sciences. 2018 Apr 15, 6 (4). pp. 618-623. ISSN : 1857-9655

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Abstract

BACKGROUND: Among the adults and children aged 5 yrs who attend PHC settings, 20-30% seeks to care for
respiratory symptoms. Over 80-90% of the respiratory patients suffer from acute respiratory infections (ARI),
followed by chronic obstructive pulmonary diseases (COPD), asthma, and less frequently with pneumonia and
tuberculosis (TB). To improve the quality of care in patients who seek assistance for respiratory symptoms in PHC
settings and the efficiency of respiratory service delivery within healthcare systems, WHO has designated several
initiatives among which one is PAL (Practical Approach to Lung Health). PAL is an integrated and symptom-based
approach focused on all priority respiratory illnesses encountered in PHC, including TB. Its patient-centred
syndromic approach aims to improve the quality of diagnosis and treatment of respiratory illnesses in a PHC
setting.
AIM: To evaluate the short-term impact of PAL approach in improving the management of patients with the most
frequent respiratory diseases by the GPs from PHC settings in the Republic of Macedonia.
MATERIAL AND METHODS: A total of 588 GPs were educated for the most frequent respiratory diseases during
the PAL training from 2013-2016. To evaluate the efficiency of GPs education from PHC settings, GPs fill in a
form out of 69 questions for the patients enrolled before (baseline survey) and after PAL training (impact survey),
and the results of the two surveys were compared. This analysis aimed to assess if the theoretical and practical
skills obtained during the PAL training have been used in the routine practice of the GPs who attended the
training and to what degree.
RESULTS: Our results showed that in the impact study more patients with ARI (P < 0.000001) and more patients
with COPD exacerbations were treated in the PHC settings (P < 0.000008). More patients suspected of asthma
were referred to upper health level for diagnosis (P < 0.037). The comparison of the findings between the baseline
and impact surveys suggest that training on PAL had an impact in decreasing drug prescription through a
reduction in a prescription for antibiotics for ARI, COPD and asthma. Our study indicates that training on PAL is
likely to increase the prescription of inhaled corticosteroids and tends to decrease the prescription of other
formulation of these drugs (P < 0.0000001). The impact surveys showed that the patients with COPD and
pneumonia in the PHC settings were better managed due to the more frequent use of CAT questionnaires and
CURB test. And regarding TB cases, our study indicates that the GPs were more aware of this disease and were
more willing to take part in the patient treatment follow-up (P < 0.000001).
CONCLUSION: The results from this study showed that implementation of PAL approach for GPs from the PHC
setting in our country have positive results (effect) in the management of patients with respiratory symptoms: it is
likely to reduce prescribing for antibiotics, to increase the use of inhalation medication which is highly
recommended in the management of asthma and COPD, and to decrease the referral of patients with chronic
diseases to the upper health level. However, more experience is needed for long-term influence on the effects
over the cost-effectiveness of respiratory care services and on strengthening the health care system.

Item Type:	Article
Subjects:	Medical and Health Sciences > Clinical medicine
Divisions:	Faculty of Medical Science
Depositing User:	Biljana Ilievska Poposka
Date Deposited:	03 Mar 2021 12:18
Last Modified:	03 Mar 2021 12:18
URI:	https://eprints.ugd.edu.mk/id/eprint/27875

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