title: Implementation of 'matrix support' (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil: a pilot observational study.
abstract: 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.
authors.affiliation: Department of Community Health of the Faculty of Medicine of ABC (FMABC), São Bernardo do Campo, São Paulo, Brazil.|Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil.
authors.forename: Sonia Maria
authors.initials: SM
authors.lastname: Martins
authors.affiliation: Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil.|Pulmonology Service of the University São Camilo Medical School, São Paulo, Brazil.
authors.forename: William
authors.initials: W
authors.lastname: Salibe-Filho
authors.affiliation: Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil.
authors.forename: Luís Paulo
authors.initials: LP
authors.lastname: Tonioli
authors.affiliation: Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil.
authors.forename: Luís Eduardo
authors.initials: LE
authors.lastname: Pfingesten
authors.affiliation: Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil.|PHC Division-Health Secretary, São Bernardo do Campo, São Paulo, Brazil.
authors.forename: Patrícia Dias
authors.initials: PD
authors.lastname: Braz
authors.affiliation: International Primary Care Respiratory Group (IPCRG), Westhill, Scotland, UK.
authors.forename: Juliet
authors.initials: J
authors.lastname: McDonnell
authors.affiliation: International Primary Care Respiratory Group (IPCRG), Westhill, Scotland, UK.
authors.forename: Siân
authors.initials: S
authors.lastname: Williams
authors.affiliation: Specialized Department, São Bernardo do Campo, São Paulo, Brazil.
authors.forename: Débora
authors.initials: D
authors.lastname: do Carmo
authors.affiliation: Community Health, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Portugal, Horizonte Family Health Unit, Matosinhos, Portugal.
authors.forename: Jaime Correia
authors.initials: JC
authors.lastname: de Sousa
authors.affiliation: Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
authors.affiliation: Pulmonary Division-Heart Institute (InCor)-Hospital da Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: Stelmach
mesh_terms: D001249:Asthma / Q000628:therapy*; D001938:Brazil; D004493:Education; D004502:Education, Medical, Continuing / Q000379:methods*; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration; D010865:Pilot Projects; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D058996:Quality Improvement; D012017:Referral and Consultation / Q000706:statistics & numerical data*