Multidisciplinary education with a focus on COPD in primary health care

This was a quasi-experimental study involving a multidisciplinary team working at a primary health care clinic. The level of knowledge about COPD was measured by applying a specific, 16-item questionnaire - before, immediately after, and three months after the video lessons. In a set of six structured video lessons, the training focused on the prevention, case-finding, treatment, and monitoring of cases of COPD. The data were analyzed with the Friedman test, the Kruskal-Wallis test, Tukey’s post hoc test, Dunnett’s test, and the Bonferroni test.

Results:

There was a significant difference between the periods before and immediately after the training in terms of the scores on 15 of the 16 items on the questionnaire regarding the level of knowledge about COPD. The median total score of the participants increased significantly, from 60 points before the training to 77 points immediately thereafter and 3 months thereafter (p < 0.001 for both). Before the training, 23 (63.9%) and 13 (36.1%) of the members of the multidisciplinary team presented strong and very strong levels of agreement, respectively, among the 16 questionnaire items. After the training, 100% of the individuals presented a very strong degree of agreement.

Conclusions:

Multidisciplinary education through video lessons increased the knowledge of COPD on the part of a primary health care team, and the knowledge acquired was retained for at least three months after the intervention.

Keywords:
Instructional films and videos; Pulmonary disease, chronic obstructive; Inservice training; Primary health care; Education, medical

Response per item	Participants, n (%)				Scores
Response per item	1 Strongly disagree	2 Disagree	3 Undecided	4 Agree	5 Strongly agree	Mean ± SD	Median (95% CI)
1) Being a smoker/former smoker is not a risk factor for COPD.
1-A	22 (61.1)^a	9 (25.0)	1 (2.8)	0 (0)	4 (11.1)	1.75 ± 1.27	1.00 (1.31-2.18)
1-B	30 (83.3)^a	5 (13.9)	0 (0)	0 (0)	1 (2.8)	1.25 ± 0.73	1.00 (1.00-1.49)
1-C	30 (83.3)^a	5 (13.9)	0 (0)	0 (0)	1 (2.8)	1.5 ± 0.73	1.00 (1.00-1.49)
2) The leading causes of COPD are cigarette smoking and wood stove smoke.
2-A	1 (2.8)	3 (8.3)	1 (2.8)	21 (58.3)	10 (27.8)^a	4.00 ± 0.95	4.00 (3.76-4.32)
2-B	0 (0)	0 (0)	0 (0)	5 (13.9)	31 (86.1)^a	4.86 ± 0.35	5.00 (4.74-4.97)
2-C	0 (0)	0 (0)	0 (0)	3 (8.3)	33 (91.7)^a	4.92 ± 0.28	5.00 (4.82-5.01)
3) Counseling for approximately 3 to 10 minutes can help patients quit smoking.
3-A	5 (13.9)	7 (19.4)	6 (16.7)	14 (38.9)	4 (11.1)^a	3.13 ± 1.26	3.50 (2.70-3.56)
3-B	2 (5.6)	0 (0)	0 (0)	3 (8.3)	31 (86.1)^a	4.69 ± 0.95	5.00 (4.37-5.01)
3-C	1 (2.8)	0 (0)	3 (8.3)	6 (16.7)	25 (72.2)^a	4.56 ± 0.87	5.00 (4.25-4.85)
4) Group counseling is not a primary health care action aimed at assisting patients undergoing a critical smoking withdrawal phase.
4-A	16 (44.4)^a	14 (38.9)	3 (8.3)	2 (5.6)	1 (2.8)	1.83 ± 1.00	2.00 (1.49-2.17)
4-B	32 (88.9)^a	1 (2.8)	0 (0)	0 (0)	3 (8.3)	1.36 ± 1.12	1.00 (0.98-1.74)
4-C	31 (86.1)^a	4 (11.1)	0 (0)	0 (0)	1 (2.8)	1.22 ± 0.72	1.00 (0.97-1.46)
5) Magazines and booklets are ways to educate COPD patients about their health care.
5-A	0 (0)	0 (0)	3 (8.3)	20 (55.6)	13 (36.1)^a	4.27 ± 0.61	4.00 (4.06-4.48)
5-B	0 (0)	0 (0)	0 (0)	2 (5.6)	34 (94.4)^a	4.94 ± 0.23	5.00 (4.86-5.02)
5-C	0 (0)	0 (0)	0 (0)	5 (13.9)	31 (86.1)^a	4.86 ± 0.35	5.00 (4.74-4.97)
6) COPD symptoms appear slowly and progressively.
6-A	0 (0)	0 (0)	3 (8.3)	21 (58.3)	12 (33.3)^a	4.25 ± 0.60	4.00 (4.04-4.45)
6-B	0 (0)	0 (0)	0 (0)	4 (11.1)	32 (88.9)^a	4.88 ± 0.31	5.00 (4.78-4.99)
6-C	0 (0)	0 (0)	0 (0)	5 (13.9)	31 (86.1)^a	4.86 ± 0.35	5.00 (4.74-4.97)
7) Frequent cough is a symptom of COPD.
7-A	1 (2.8)	6 (16.7)	12 (33.3)	14 (38.9)	3 (8.3)^a	3.33 ± 0.95	3.00 (3.01-3.65)
7-B	0 (0)	0 (0)	0 (0)	3 (8.3)	33 (91.7)^a	4.91 ± 0.28	5.00 (4.82-5.01)
7-C	0 (0)	1 (2.8)	1 (2.8)	9 (25.0)	25 (69.4)^a	4.61 ± 0.68	5.00 (4.37-4.84)
8) Influenza and pneumonia vaccines do not reduce the number of COPD exacerbations.
8-A	7 (19.4)^a	14 (38.9)	6 (16.7)	7 (19.4)	2 (5.6)	2.52 ± 1.18	2.00 (2.12-2.92)
8-B	26 (72.2)^a	6 (16.7)	0 (0)	1 (2.8)	3 (8.3)	1.58 ± 1.20	1.00 (1.17-1.99)
8-C	28 (77.8)^a	3 (8.3)	1 (2.8)	2 (5.6)	2 (5.6)	1.53 ± 1.15	1.00 (1.13-1.91)
9) The use of oxygen in COPD patients will cause dependence.
9-A	6 (16.7)^a	17 (47.2)	8 (22.2)	5 (13.9)	0 (0)	2.33 ± 0.92	2.00 (2.02-2.64)
9-B	29 (80.6)^a	6 (16.6)	0 (0)	0 (0)	1 (2.8)	1.27 ± 0.74	1.00 (1.02-1.52)
9-C	27 (75.0)^a	8 (22.2)	0 (0)	1 (2.8)	0 (0)	1.31 ± 0.62	1.00 (1.09-1.51)
10) Practicing physical exercise can improve the autonomy and physical/social performance of COPD patients.
10-A	0 (0)	1 (2.8)	0 (0)	22 (61.1)	13 (36.1)^a	4.30 ± 0.62	4.00 (4.09-4.51)
10-B	0 (0)	0 (0)	0 (0)	2 (5.6)	34 (94.4)^a	4.94 ± 0.23	5.00 (4.86-5.02)
10-C	0 (0)	0 (0)	0 (0)	4 (11.1)	32 (88.9)^a	4.89 ± 0.31	5.00 (4.78-4.99)
11) As part of COPD treatment, it is important to talk about the myths and prejudices against the use of inhalers, oxygen therapy, and physical exercise.
11-A	0 (0)	0 (0)	4 (11.1)	23 (63.9)	9 (25.0)^a	4.13 ± 0.59	4.00 (3.93-4.33)
11-B	0 (0)	0 (0)	0 (0)	5 (13.9)	31 (86.1)^a	4.86 ± 0.35	5.00 (4.74-4.97)
11-C	0 (0)	0 (0)	0 (0)	7 (19.4)	29 (80.6)^a	4.81 ± 0.40	5.00 (4.66-4.94)
12) The right sequence for using inhaled medications is: 1) exhale normally, 2) place the mouthpiece in your mouth, 3) inhale deeply, 4) close your mouth and hold the air in your lungs for approximately ten seconds.
12-A	1 (2.8)	2 (5.6)	16 (44.4)	8 (22.2)	9 (25.0)^a	3.61 ± 1.02	3.00 (3.26-3.95)
12-B	0 (0)	0 (0)	0 (0)	5 (13.9)	31 (86.1)^a	4.86 ± 0.35	5.00 (4.74-4.97)
12-C	0 (0)	0 (0)	3 (8.3)	3 (8.3)	30 (83.3)^a	4.75 ± 0.60	5.00 (4.54-4.95)
13) The treatment of COPD includes: pharmacological and nonpharmacological therapy, education, and guidance on a healthy life style.
13-A	0 (0)	1 (2.8)	1 (2.8)	22 (61.1)	12 (33.3)^a	4.25 ± 0.64	4.00 (4.03-4.46)
13-B	0 (0)	0 (0)	0 (0)	3 (8.3)	33 (91.7)^a	4.91 ± 0.28	5.00 (4.82-5.01)
13-C	0 (0)	0 (0)	0 (0)	4 (11.1)	32 (88.9)^a	4.89 ± 0.31	5.00 (4.78-4.99)
14) The term “counter-referral” means: COPD patients referred to the primary health care center by a secondary or tertiary health care center, along with information on their diagnosis and treatment.
14-A	0 (0)	0 (0)	15 (41.6)	10 (27.8)	11 (30.6)^a	3.88 ± 0.85	4.00 (3.59-4.17)
14-B	0 (0)	1 (2.8)	1 (2.8)	1 (2.8)	33 (91.6)^a	4.83 ± 0.60	5.00 (4.62-5.03)
14-C	0 (0)	0 (0)	0 (0)	3 (8.3)	33 (91.7)^a	4.92 ± 0.28	5.00 (4.82-5.01)
15) When the health care team provides guidance on physical exercise to COPD patients, it is important to provide them with a scale to manage their shortness of breath.
15-A	0 (0)	1 (2.8)	13 (36.1)	17 (47.2)	5 (13.9)^a	3.72 ± 0.73	4.00 (3.47-3.97)
15-B	0 (0)	0 (0)	0 (0)	7 (19.4)	29 (80.6)^a	4.80 ± 0.40	5.00 (4.55-4.94)
15-C	0 (0)	0 (0)	1 (2.8)	7 (19.4)	28 (77.8)^a	4.75 ± 0.50	5.00 (4.58-4.91)
16) All patients who are diagnosed with COPD should be referred to a pulmonologist.
16-A	1 (2.8)	5 (13.9)^a	3 (8.3)	19 (52.8)	8 (22.2)	3.77 ± 1.04	4.00 (3.42-4.13)
16-B	7 (19.5)	26 (72.2)^a	0 (0)	2 (5.5)	1 (2.8)	2.00 ± 0.82	2.00 (1.71-2.28)
16-C	3 (8.3)	26 (72.2)^a	2 (5.6)	2 (5.6)	3 (8.3)	2.33 ± 1.01	2.00 (1.99-2.67)

Item	A	B	C	p^a	p^b	p^c
Item	Score, mean ± SD
1	1.75 ± 1.27	1.25 ± 0.73	1.25 ± 0.73	0.03	0.06	0.85
2	4.00 ± 0.96	4.86 ± 0.35	4.92 ± 0.28	< 0.001	< 0.001	0.48
3	3.14 ± 1.27	4.69 ± 0.95	4.56 ± 0.88	< 0.001	< 0.001	0.32
4	1.83 ± 1.00	1.36 ± 1.13	1.22 ± 0.72	< 0.001	< 0.001	0.48
5	4.28 ± 0.61	4.94 ± 0.23	4.86 ± 0.35	< 0.001	< 0.001	0.26
6	4.25 ± 0.60	4.89 ± 0.32	4.86 ± 0.35	< 0.001	< 0.001	0.71
7	3.33 ± 0.96	4.92 ± 0.28	4.61 ± 0.69	< 0.001	< 0.001	0.01
8	2.53 ± 1.18	1.58 ± 1.20	1.53 ± 1.16	< 0.001	< 0.001	0.59
9	2.33 ± 0.93	1.28 ± 0.74	1.31 ± 0.62	< 0.001	< 0.001	0.33
10	4.31 ± 0.62	4.94 ± 0.23	4.89 ± 0.32	< 0.001	< 0.001	0.32
11	4.14 ± 0.59	4.86 ± 0.35	4.81 ± 0.40	< 0.001	< 0.001	0.48
12	3.61 ± 1.02	4.86 ± 0.35	4.75 ± 0.60	< 0.001	< 0.001	0.33
13	4.25 ± 0.65	4.92 ± 0.28	4.89 ± 0.32	0.71	< 0.001	< 0.001
14	3.89 ± 0.85	4.83 ± 0.61	4.92 ± 0.28	< 0.001	< 0.001	0.48
15	3.72 ± 0.74	4.81 ± 0.40	4.75 ± 0.50	< 0.001	< 0.001	0.59
16	3.78 ± 1.05	2.00 ± 0.83	2.33 ± 1.01	< 0.001	< 0.001	0.56

Time point	Primary health care professionals
Time point	Community agent	Dentist	Nurse	Physician	Nursing assistant	p*
	Total score, mean ± SD
A	57.00 ± 5.17^†	61.86 ± 5.52	61.75 ± 4.98	67.17 ± 6.49^††	57.17 ± 4.17	0.02
B	74.67 ± 3.91	77.57 ± 2.07	77.63 ± 2.00	77.50 ± 2.43	72.67 ± 4.89	0.10
C	72.11 ± 5.67^¶	75.71 ± 3.45	77.88 ± 1.36	77.00 ± 4.05	73.67 ± 3.93	0.03

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E-mail: jbp@sbpt.org.br

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[1] Correspondence to:
Erikson Custódio Alcântara. Avenida T-13, 1033, Edifício Borges Landeiro Classic, apto. 1601 (Torre Mozart), Setor Bueno, CEP 74230-050, Goiânia, GO, Brazil. Tel.: 55 62 99602-7420 or 55 62 3255-5278. E-mail: eriksonalcantara@hotmail.com