The PRIME Study Dr. Komalkirti Apte Perceived need for chronic Respiratory dIsease ManagErs: Dr. Komalkirti Apte Ms. Madhuragauri Shevade, Ms. Sapna Madas, Dr. Sundeep Salvi. Chest Research Foundation, Pune

The need for this study Chronic respiratory diseases More time per patient More effort per patient Additional assistance required for managing these patients Chronic respiratory diseases Respiratory practice Rx ----------- to be continued until asked to stop counseling additional repeated diagnostic tests adherence issues long term follow up and treatment plans Acute respiratory diseases Rx ----------- x 7 – 14 days

Differences in healthcare across the globe Developed countries Doctor’s assistant Asthma Nurse COPD Nurse Bronchiectasis Nurse OAD Counselor Trained technicians Developing countries Junior doctors working as part of their medical curricula Nurses with no formal training on specialized disease management Technicians in some instances, albeit without formal training Quality of care Quality of care

IPCRG Member countries 26 full voting member countries

The IPCRG Asset A good global spread Well developed network of like-minded investigators and research coordinators Experience of conducting network studies Answering practically important questions relevant to clinical practice

Research Question ?? Do primary care physicians have a qualified assistant to assist them in managing patients of chronic respiratory diseases across the global IPCRG Countries?

Research Question ?? If the primary care physician has assistance: What is the level of qualification of their assistant? What are the skill sets of these assistants? Do these assistants meet the expectation of the physician? Which additional skills training will help the assistant meet the expectation of the physician?

Research Question ?? If the primary care physician does not have assistance: Is there a perceived need for assistance in managing patients of chronic respiratory diseases? In the opinion of the physician, does the lack of assistance have an impact on the quality of care offered to his/ her patients? What should be the knowledge base of the assistant? What skill sets would the physician like an assistant to be trained in?

Research Tool Questionnaire based survey: Pattern of patient consults Availability of assistance in managing patients of chronic respiratory diseases Level of qualification of the assistance Skill sets of the assistant Requirement of competencies in the skills of the assistant

National Coordinators Research Methodology 50 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 National Coordinators Coordinating center 50 N=1000

Research Methodology As a coordinating center: Develop the final questionnaire through consensus with National Investigators Develop the online software for data collection Training National Coordinators Remote monitoring in conjunction with the National Coordinators Query generation and resolution Data analysis with inputs from National Investigators Report sharing with national investigators

National Coordinators trained on the software and questionnaire Flow of the study Finalizes the protocol, questionnaire and software for online data capture National Coordinators trained on the software and questionnaire National Coordinators maintain a list of recruitment of 50 PCPs from their country Data cleaning and database lock by CRF, Analyses in consultation with National Investigators 3 months 3 months 1.5 months 3 months

Questions to discuss Countries interested in participating Feasibility of the study? Will this study help shape up a standard program for training a second tier of healthcare providers? Could the IPCRG like to take a lead role in creating this much required skilled and qualified resource? Operational questions? Countries interested in participating National Investigator’s list National Coordinator’s list Foreseeable challenges in study recruitment Time lines