Evaluation of the effectiveness of implemention of the practical approach to lung health (PALSA) in the Free State

• Main Author: Majara, Bosielo Phillip
• Other Authors: Joubert, G, Bachmann, O. M.
• Format: Thesis
• Language: English
• Published: University of the Free State 2005
• Subjects: Academic detailing; Cluster randomized controlled trial; Effectiveness; Evaluation; Guidelines; Multifaceted intervention; Primary respiratory care; Respiratory conditions; Tuberculosis; Practical Approach to Lung Health in South Africa (PALSA); Tuberculosis > South Africa > Free State; Respiratory organs > Diseases > South Africa > Free State; Primary health care > South Africa > Free State; Thesis (Ph.D. (Community Health)) > University of the Free State; 2005; Daly; palsa
• Online Access: http://hdl.handle.net/11660/6153

English: Currently, respiratory diseases constitute about one third of patients that present to primary care clinics in under-resourced countries of the world. Communicable respiratory diseases such as tuberculosis, acute respiratory infections in adults and non-communicable respiratory diseases such as asthma, chronic obstructive pulmonary disease, lung cancer represent about one-fifth of the global burden of disease measured in disability adjusted life years (DALY). Opportunistic infections, other respiratory complications, and the widespread use of tobacco further increase the respiratory disease burden in high HIV prevalence settings. In developing countries clinic nurses with limited training and basic skills are entrusted to properly diagnose and treat respiratory patients from overloaded clinics. We developed an educational outreach intervention, Practical Approach to Lung Health in South Africa (PALSA) on integrated respiratory case management aimed at improving the quality of respiratory care in South African primary care clinics. The intervention comprised 3 to 4 academic detailing training sessions of primary care nursing practitioners; dissemination of locally adapted PALSA guidelines and support materials; changes in prescribing provisions for primary care nurses, and doctors' sensitization about PALSA. The impact of PALSA on the processes and outcomes of respiratory care was evaluated through a pragmatic cluster randomized controlled trial in the Free State province in 2003. A total of 1000 patients in the intervention arm and 999 patients in the control arm presenting with respiratory conditions to the 40 largest primary care clinics of the Free State province were interviewed at the first post-intervention survey. The number of patients recruited ranged from 47 to 52 patients per clinic. The follow up rate was 92.9% for the intervention arm and 92.7% for the control arm. Twenty two patients died in the intervention clinics and twenty six died in the control clinics. During data analysis, four ...