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Pegoraro F, Masini M, Giovannini M, Barni S, Mori F, du Toit G, Bartha I, Lombardi E. Asthma Action Plans: An International Review Focused on the Pediatric Population. Front Pediatr 2022; 10:874935. [PMID: 35592848 PMCID: PMC9113391 DOI: 10.3389/fped.2022.874935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Marzio Masini
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
| | - Mattia Giovannini
- Department of Health Sciences, University of Florence, Florence, Italy
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
- Pediatric Allergy Group, Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
| | - George du Toit
- Pediatric Allergy Group, Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
- Children’s Allergy Service, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Irene Bartha
- Pediatric Allergy Group, Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
- Children’s Allergy Service, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Enrico Lombardi
- Pulmonary Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
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Hanna T, Bajorek B, Lemay K, Armour CL. Using scenarios to test the appropriateness of pharmacist prescribing in asthma management. Pharm Pract (Granada) 2014; 12:390. [PMID: 24644524 PMCID: PMC3955869 DOI: 10.4321/s1886-36552014000100009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 03/08/2014] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists' confidence, and appropriateness, in the context of asthma management. METHODS Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers. RESULTS In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. CONCLUSIONS Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way.
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Affiliation(s)
- Tamer Hanna
- The University of Sydney . Sydney, NSW ( Australia )
| | - Beata Bajorek
- University of Technology Sydney . Sydney, NSW ( Australia )
| | - Kate Lemay
- Woolcock Institute of Medical Research, The University of Sydney . Sydney, NSW ( Australia )
| | - Carol L Armour
- Woolcock Institute of Medical Research, The University of Sydney . Sydney, NSW ( Australia ).
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Sulaiman N, Aroni R, Thien F, Schattner R, Simpson P, Del Colle E, Wolfe R, Abramson M. Written Asthma Action Plans (WAAPs) in Melbourne general practices: a sequential mixed methods study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2011; 20:161-9, 1 p following 169. [PMID: 21336464 DOI: 10.4104/pcrj.2011.00010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM To investigate ownership and perceived utility of written asthma action plans (WAAPs) in general practice. METHODS Questionnaires were completed by 225 adults and 75 children with GP-diagnosed asthma from 31 practices. Regression models for WAAP ownership allowed for confounders and clustering by practice. Five audio-recorded focus groups were conducted before questionnaire implementation and, 12 months later, six focus groups and additional in-depth interviews with 29 patients and 16 doctors were conducted. Transcripts were submitted to content and thematic analyses. RESULTS A total of 37% of adults and 47% of children had WAAPs. Adults reporting spontaneous shortness of breath, an emergency presentation in the previous 12 months, or frequent GP visits were more likely to have a WAAP. Qualitative data indicated that few acknowledged receipt or use of one. Those who remembered receiving a WAAP found it useful in asthma management in conjunction with verbal advice given by their GP. WAAPs were perceived by some patients as an indicator of doctor competence which, in turn, was viewed as signifying better management of asthma by the patient even if the WAAP was never actually used. CONCLUSIONS Ownership of WAAPs is still low. Additional and more effective strategies are required to improve rates of GP prescription of WAAPs.
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Affiliation(s)
- Nabil Sulaiman
- Department of Family and Community Medicine, University of Sharjah, Sharjah University City, United Arab Emirates.
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Bereznicki B, Peterson G, Jackson S, Haydn Walters E, DeBoos I, Hintz P. Perceived feasibility of a community pharmacy-based asthma intervention: a qualitative follow-up study. J Clin Pharm Ther 2010; 36:348-55. [PMID: 21545614 DOI: 10.1111/j.1365-2710.2010.01187.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Asthma is a National Health Priority Area in Australia; however, recent evidence suggests that its management remains suboptimal. Community pharmacists are in a unique position to help patients manage asthma, and a number of community pharmacy-based asthma interventions have demonstrated effectiveness with improved patient outcomes. This study aimed to explore the views of general practitioners (GPs), community pharmacists and patients towards a pharmacy-based intervention that saw patients with poorly managed asthma supplied with educational material and referred to their GP for an asthma management review. METHODS A qualitative follow-up study of participants who had been involved in the intervention was conducted. A sample of six GPs, 10 community pharmacists and 10 patients participated in semi-structured face-to-face interviews. Data were analysed using interpretive phenomenology. RESULTS AND DISCUSSION General practitioners accepted the intervention process if they had positive relationships with pharmacists. There was also some hesitance of GPs towards the intervention, related to a perceived encroachment on their area of responsibility and a perceived conflict of interest of pharmacists in providing health care. GPs indicated the need to be more involved with the intervention process, and expressed that patients were rarely forthcoming about problems with their asthma. Community pharmacists felt that patients can be apathetic about asthma and often fail to seek medical advice. The intervention was implemented very easily, with minimal disruptions to the pharmacists' workflow, and pharmacists suggested that it would be better if GPs were more involved with the intervention process. Patients' general satisfaction with pharmacy services was high, but their expectations were quite low. Although there was an appreciation by patients of community pharmacists' interest in their health, this did not necessarily translate into appointments with GPs for an asthma management review. The reason for this related primarily to patients' under-estimation of their asthma severity. WHAT IS NEW AND CONCLUSION A wider rollout of the asthma intervention, with an improved process for involving GPs, would be feasible and well accepted. Further research should determine the best approach in influencing patients' perceptions of asthma control and whether these perceptions are amenable to a more intensive educational intervention. This could result in more efficient asthma interventions, translating to improved patient outcomes.
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Affiliation(s)
- B Bereznicki
- Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Hobart, Tas., Australia.
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Sulaiman ND, Barton CA, Liaw ST, Harris CA, Sawyer SM, Abramson MJ, Robertson C, Dharmage SC. Do small group workshops and locally adapted guidelines improve asthma patients' health outcomes? A cluster randomized controlled trial. Fam Pract 2010; 27:246-54. [PMID: 20332178 DOI: 10.1093/fampra/cmq013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To improve health outcomes of children and adolescents with asthma using a multifaceted intervention for GPs. METHODS The design of the study was a cluster randomized controlled trial. GPs were randomized at a practice level in general practice clinics in Melbourne, Australia. Participants were children/adolescents aged 2-14 years with asthma and their caregivers identified from the medical records of participating clinics. Questionnaires were completed by 411 at baseline and 341 at follow-up. The intervention arm (n = 18 GPs) participated in a small group asthma education programme and was provided with locally adapted paediatric asthma guidelines. One control arm (n = 18 GPs) received only the adapted paediatric asthma guidelines, while the other control arm (n = 15 GPs) received an unrelated educational intervention. The outcome measures of the study were children/adolescents and caregivers completed questionnaires about asthma management and control, asthma knowledge and quality of life at recruitment and 6 months later. Ownership of a written asthma action plan (WAAP) was the primary outcome. RESULTS There was no evidence for changes in ownership of WAAPs between the three study arms. Adolescents in the intervention group reported an improvement in quality of life subscale score 'positive effects' (mean difference = 2.64, P = 0.01), but there was no evidence for an effect of the intervention on other study outcomes among the three study arms. CONCLUSIONS The intervention was associated with some improvement in quality of life for adolescents. However, overall, the intervention did not translate into increased ownership of WAAPs, control of asthma or improved quality of life.
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Affiliation(s)
- Nabil D Sulaiman
- Department of Family and Community Medicine and Behavioural Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Bereznicki BJ, Peterson GM, Jackson SL, Walters H, Fitzmaurice K, Gee P. Pharmacist-initiated general practitioner referral of patients with suboptimal asthma management. ACTA ACUST UNITED AC 2008; 30:869-75. [PMID: 18679820 DOI: 10.1007/s11096-008-9242-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 07/20/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the impact of an intervention initiated by community pharmacists, involving the provision of educational material and general practitioner (GP) referral, on asthma knowledge and self-reported asthma control and asthma-related quality of life (QOL) in patients who may have suboptimal management of their asthma, as evidenced by pharmacy dispensing records. Setting Community pharmacies throughout Tasmania, Australia. METHODS Forty-two pharmacies installed a software application that data mined dispensing records and generated a list of patients with suboptimal asthma management, as indicated by having three or more canisters of inhaled short-acting beta-2-agonists dispensed in the preceding 6 months. Identified patients were randomised to an intervention or control group. At baseline, intervention patients were mailed intervention packs consisting of a letter encouraging them to see their GP for a review, educational material, asthma knowledge, asthma control and asthma-related QOL questionnaires, and a letter with a dispensing history to give to their GP. Pharmacists were blinded to the control patients' identities for 6 months, after which time intervention patients were sent repeat questionnaires, and control patients were sent intervention packs. MAIN OUTCOME MEASURES Asthma knowledge, asthma control and asthma-related QOL scores. RESULTS Thirty-five pharmacies completed the study, providing 706 intervention and 427 control patients who were eligible to receive intervention packs. Intervention patients' asthma control and asthma-related QOL scores at 6 months were significantly higher compared to the control patients (P < 0.01 and P < 0.05, respectively) and to the intervention patients' baseline scores (P < 0.001 and P < 0.05, respectively). Symptom-related QOL was significantly higher compared to the control patients (P < 0.01) and activities-related QOL significantly improved compared to baseline (P < 0.05). No significant change was observed in asthma knowledge. CONCLUSION The results suggest that community pharmacists are ideally placed to identify patients with suboptimal asthma management and refer such patients for a review by their GP. This type of collaborative intervention can significantly improve self-reported asthma control and asthma-related QOL in patients identified as having suboptimal management of their asthma. A larger trial is needed to confirm the effects are real and sustained.
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Affiliation(s)
- Bonnie J Bereznicki
- Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Tasmania, Australia.
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Liaw ST, Sulaiman ND, Barton CA, Chondros P, Harris CA, Sawyer S, Dharmage SC. An interactive workshop plus locally adapted guidelines can improve general practitioners asthma management and knowledge: a cluster randomised trial in the Australian setting. BMC FAMILY PRACTICE 2008; 9:22. [PMID: 18423050 PMCID: PMC2375877 DOI: 10.1186/1471-2296-9-22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 04/20/2008] [Indexed: 11/10/2022]
Abstract
BACKGROUND A cluster randomised trial was conducted to determine the effectiveness of locally adapted practice guidelines and education about paediatric asthma management, delivered to general practitioners (GPs) in small group interactive workshops. METHODS Twenty-nine practices were randomly allocated to one of three study arms. Australian asthma management guidelines were adapted to accommodate characteristics of the local area. GPs in the intervention arm (Group 1, n = 18 GPs) participated in a small group based education program and were provided with the adapted guidelines. One control arm (Group 2, n = 18 GPs) received only the adapted guidelines, while the other control arm (Group 3, n = 15 GPs) received an unrelated education intervention. GPs' knowledge, attitudes and management of paediatric asthma was assessed. RESULTS Post intervention, intervention arm GPs were no more likely to provide a written asthma action plan, but were better able to assess the severity of asthma attack (Group 1vs Group 2 p = 0.05 and Group 1 vs Group 3 p = 0.01), better able to identify patients at high risk of severe attack (Group 1vs Group 3 p = 0.06), and tended to score higher on the asthma knowledge questionnaire (Group 1 vs Group 2 p = 0.06 and Group 1 vs Group 3 p = 0.2). Most intervention arm GPs felt more confident than control GPs to manage acute asthma attack and ongoing management of infrequent episodic asthma. CONCLUSION Using interactive small group workshops to disseminate locally adapted guidelines was associated with improvement in GP's knowledge and confidence to manage asthma, but did not change GP's self-reported provision of written action plans.
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Affiliation(s)
- Siaw-Teng Liaw
- Department of Rural Health, The University of Melbourne, Australia
| | - Nabil D Sulaiman
- Department of General Practice, The University of Melbourne and Department of Family and Community Medicine and Behavioural Sciences, University of Sharjah, United Arab Emirates
| | | | - Patty Chondros
- Department of General Practice, The University of Melbourne and Department of Family and Community Medicine and Behavioural Sciences, University of Sharjah, United Arab Emirates
| | - Claire A Harris
- Centre for Clinical Effectiveness, Monash Institute of Health Services Research, Australia
| | - Susan Sawyer
- Centre for Adolescent Health and Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Shyamali C Dharmage
- Centre for MEGA Epidemiology, School of Population Health, The University of Melbourne, Australia
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8
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Armour C, Bosnic-Anticevich S, Brillant M, Burton D, Emmerton L, Krass I, Saini B, Smith L, Stewart K. Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community. Thorax 2007; 62:496-502. [PMID: 17251316 PMCID: PMC2117224 DOI: 10.1136/thx.2006.064709] [Citation(s) in RCA: 202] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite national disease management plans, optimal asthma management remains a challenge in Australia. Community pharmacists are ideally placed to implement new strategies that aim to ensure asthma care meets current standards of best practice. The impact of the Pharmacy Asthma Care Program (PACP) on asthma control was assessed using a multi-site randomised intervention versus control repeated measures study design. METHODS Fifty Australian pharmacies were randomised into two groups: intervention pharmacies implemented the PACP (an ongoing cycle of assessment, goal setting, monitoring and review) to 191 patients over 6 months, while control pharmacies gave their usual care to 205 control patients. Both groups administered questionnaires and conducted spirometric testing at baseline and 6 months later. The main outcome measure was asthma severity/control status. RESULTS 186 of 205 control patients (91%) and 165 of 191 intervention patients (86%) completed the study. The intervention resulted in improved asthma control: patients receiving the intervention were 2.7 times more likely to improve from "severe" to "not severe" than control patients (OR 2.68, 95% CI 1.64 to 4.37; p<0.001). The intervention also resulted in improved adherence to preventer medication (OR 1.89, 95% CI 1.08 to 3.30; p = 0.03), decreased mean daily dose of reliever medication (difference -149.11 microg, 95% CI -283.87 to -14.36; p=0.03), a shift in medication profile from reliever only to a combination of preventer, reliever with or without long-acting beta agonist (OR 3.80, 95% CI 1.40 to 10.32; p=0.01) and improved scores on risk of non-adherence (difference -0.44, 95% CI -0.69 to -0.18; p=0.04), quality of life (difference -0.23, 95% CI -0.46 to 0.00; p=0.05), asthma knowledge (difference 1.18, 95% CI 0.73 to 1.63; p<0.01) and perceived control of asthma questionnaires (difference -1.39, 95% CI -2.44 to -0.35; p<0.01). No significant change in spirometric measures occurred in either group. CONCLUSIONS A pharmacist-delivered asthma care programme based on national guidelines improves asthma control. The sustainability and implementation of the programme within the healthcare system remains to be investigated.
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Affiliation(s)
- Carol Armour
- Faculty of Pharmacy, Pharmacy Building A15, The University of Sydney, NSW 2006, Australia.
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9
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Abstract
Asthma self-management education is a fundamental component of asthma management guidelines. Self-management education should include the provision of information, self-monitoring, regular medical review and the provision of a written asthma management plan. Implementing this form of management can be challenging, this paper reviews the evidence supporting self-management education, provides recommendations and tools for delivering asthma education and discusses the challenges and solutions to implementing these recommendations. We have discussed ways to improve communication, develop patient partnerships and tailor management to facilitate behavioural change, adherence and self-management. Health Professionals providing education and guiding self-management require training to acquire and maintain the skills necessary to deliver this form of education. Provision of this training is important and can be achieved through varied methods of achieving competence.
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Affiliation(s)
- V M McDonald
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
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10
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Matheson MC, Abeysena C, Raven JM, Skoric B, Johns DP, Abramson MJ, Walters EH. How have we been managing chronic obstructive pulmonary disease in Australia? Intern Med J 2006; 36:92-9. [PMID: 16472263 DOI: 10.1111/j.1445-5994.2006.01011.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Although chronic obstructive pulmonary disease (COPD) is a main cause of disability, hospital admissions and premature deaths in Australia, little is known about the community management of COPD in relation to recently published guidelines. The aim of the article was to report on COPD management in a community based cohort. METHODS A random sample of adults aged between 45 and 70 years drawn from the electoral roll participated in the study. They completed a detailed respiratory questionnaire, spirometry, methacholine challenge and measurement of transfer factor. COPD was defined according to the Global initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Current asthma was defined as wheeze during the last 12 months together with bronchial hyperreactivity. Subjects were classified as either COPD-only, asthma-only or both asthma and COPD. RESULTS Of 1224 subjects completing spirometry, 39 (3.5%) met the GOLD criteria for stage 2 or 3 COPD, asthma-only was found in 99 (8.9%) subjects and 40 (3.6%) subjects had both asthma and COPD. The COPD-only group was significantly older than the other two groups. More than 40% of subjects with COPD did not have a diagnosis of COPD from their doctors. Only 48.7% of subjects with COPD had ever been prescribed medication for their breathing. More than two-thirds of all subjects had seen a doctor for breathing problems, but very few had seen a general practitioner in the last 12 months and even fewer had respiratory function tests. CONCLUSIONS Most subjects with COPD are being undertreated. Diagnosis, monitoring and referral systems should be improved. Preventive activities such as influenza vaccination and smoking cessation should be intensified.
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Affiliation(s)
- M C Matheson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
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Boulet LP, Becker A, Bowie D, Hernandez P, McIvor A, Rouleau M, Bourbeau J, Graham ID, Logan J, Légaré F, Ward TF, Cowie RL, Drouin D, Harris SB, Tamblyn R, Ernst P, Tan WC, Partridge MR, Godard P, Herrerias CT, Wilson JW, Stirling L, Rozitis EB, Garvey N, Lougheed D, Labrecque M, Rea R, Holroyde MC, Fagnan D, Dorval E, Pogany L, Kaplan A, Cicutto L, Allen ML, Moraca S, FitzGerald JM, Borduas F. Implementing practice guidelines: a workshop on guidelines dissemination and implementation with a focus on asthma and COPD. Can Respir J 2006; 13 Suppl A:5-47. [PMID: 16552449 PMCID: PMC2806791 DOI: 10.1155/2006/810978] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The present supplement summarizes the proceedings of the symposium "Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD", which took place in Quebec City, Quebec, from April 14 to 16, 2005. This international symposium was a joint initiative of the Laval University Office of Continuing Medical Education (Bureau de la Formation Médicale Continue), the Canadian Thoracic Society and the Canadian Network for Asthma Care, and was supported by many other organizations and by industrial partners. The objectives of this meeting were to examine the optimal implementation of practice guidelines, review current initiatives for the implementation of asthma and chronic obstructive pulmonary disease (COPD) guidelines in Canada and in the rest of the world, and develop an optimal strategy for future guideline implementation. An impressive group of scientists, physicians and other health care providers, as well as policy makers and representatives of patients' associations, the pharmaceutical industry, research and health networks, and communications specialists, conveyed their perspectives on how to achieve these goals. This important event provided a unique opportunity for all participants to discuss key issues in improving the care of patients with asthma and COPD. These two diseases are responsible for an enormous human and socioeconomic burden around the world. Many reports have indicated that current evidence-based guidelines are underused by physicians and others, and that there are many barriers to an effective translation of recommendations into day-to-day care. There is therefore a need to develop more effective ways to communicate key information to both caregivers and patients, and to promote appropriate health behaviours. This symposium contributed to the initiation of what could become the "Canadian Asthma and COPD Campaign", aimed at improving care and, hence, the quality of life of those suffering from these diseases. It is hoped that this event will be followed by other meetings that focus on how to improve the transfer of key recommendations from evidence-based guidelines into current care, and how to stimulate research to accomplish this.
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Gustafsson PM, Watson L, Davis KJ, Rabe KF. Poor asthma control in children: evidence from epidemiological surveys and implications for clinical practice. Int J Clin Pract 2006; 60:321-34. [PMID: 16494648 DOI: 10.1111/j.1368-5031.2006.00798.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The objectives of this study is to compile current knowledge about asthma control in children in relation to goals proposed in international guidelines, to elucidate the factors associated with insufficient asthma control and to address the implications for clinical practice. Review of recent worldwide large population epidemiological surveys and clinical asthma studies of more than 20,000 children are the methods used in this study. The studies report high frequencies of sleep disturbances, emergency visits, school absence and limitations of physical activity due to asthma. Only a small percentage of children with asthma reach the goals of good asthma control set out by Global Initiative for Asthma (GINA). There is evidence of underuse of inhaled corticosteroids even in children with moderate or severe persistent asthma and over-reliance on short-acting beta(2)-agonist rescue medication. Both parents and physicians generally overestimate asthma control and have low expectations about the level of achievable control. Many children with asthma are not being managed in accordance with guideline recommendations, and asthma management practices vary widely between countries. Asthma control falls short of guideline recommendations in large proportions of children with asthma worldwide. Simple methods for assessing asthma control in clinical practice are needed. Treatment goals based on raised expectations should be established in partnership with the asthmatic child and the parents. Effective anti-inflammatory treatment should be used more frequently, and patients should be reviewed regularly.
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Affiliation(s)
- P M Gustafsson
- Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden.
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13
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Abramson MJ, Bailey MJ, Forbes AB, Walters EH. How well do doctors know their patients with severe asthma? Intern Med J 2004; 33:557-65. [PMID: 14656228 DOI: 10.1111/j.1444-0903.2003.00418.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rates of asthma mortality have fallen in Australia since the commencement of the National Asthma Campaign and promotion of the Australian asthma management plan. New strategies are now needed to further reduce mortality. AIM To examine agreement about key features between asthma patients and their general practitioners (GPs). METHODS We interviewed: (i) the next of kin of 56 asthma deaths, (ii) 91 asthma patients presenting to emergency departments with acute severe asthma and (iii) 147 of their GPs. RESULTS Agreement was substantial for usage of oral symptomatic medication, but poor for inhaled symptomatic and preventive medications. There was moderate agreement regarding hospital admissions within the last 12 months among the cases, but little about other markers of severity. There was moderate agreement where the presenting or fatal attack was triggered by an upper respiratory-tract infection or aspirin. The next of kin and GPs agreed about family problems, but not about other psychosocial issues. They also agreed about which cases had been given action plans or verbal instructions, but few other aspects of asthma management. There was also moderate agreement regarding the use of peak flow meters by the controls. CONCLUSIONS Doctors often have relatively poor insights into self-management practices, social background or trigger factors, even in high-risk patients. This should be considered when planning future campaigns to improve asthma management and further reduce mortality.
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Affiliation(s)
- M J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
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14
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Mo F, Robinson C, Choi BC, Li FC. Analysis of prevalence, triggers, risk factors and the related socio-economic effects of childhood asthma in the Student Lung Health Survey (SLHS) database, Canada 1996. Int J Adolesc Med Health 2004; 15:349-58. [PMID: 14719417 DOI: 10.1515/ijamh.2003.15.4.349] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to provide information to improve the management of childhood asthma in Canada. The Student Lung Health Survey (SLHS) was conducted as a stratified and multi-staged cluster survey across Canada in 1996. It included a total of 136 public, private and separate schools in nine health units. The target study population was schoolchildren aged 5 to 19 years. Among all 5-19 years old students, the prevalence of asthma was 13.0%, with the prevalence for males being higher than for females, the adjusted Odds Ratio (OR) was 1.17, (95% CI 1.14-1.19) for males, in comparison with females. The prevalence in the 15-19 age group was higher than that in the 5-9 and 10-14 age group in females, but it was higher in the 5-9 and 10-14 age group than in the 15-19 age group in males. The mean delay from the onset of symptoms to time of first diagnosis was 1, 0.4 and 0.3 years for the 1-4, 5-9 and 10-14 age group respectively. However, there was no delay in the 15-19 group. The prevalence of asthma in Prince Edward Island (17.9%), Halifax (17.1%), and Kingston (16.1%) was higher than that in Saskatoon (10.0%). Sherbrooke (9.7%) and Kelowna (11.9%). The proportion of asthma for students who smoked more than 11 cigarettes per day (OR = 1.41), were exposed to passive smoke in home (OR = 7.29), in car (OR = 4.71), and in school (OR = 4.24) or had a family income less than CAN$40,000 (OR = 1.19), was significantly higher than groups without those factors. Risk factors and socio-economic status such as living conditions and environment, pets or plants in the home, parental education levels also affected the morbidity of asthma. The results of the SLHS study demonstrated the serious burden of childhood asthma, and asthma triggers, living and environmental conditions and lifestyle influence the prevalence and the effects of childhood asthma diagnosis, treatment, and education in Canada. Asthma is still a serious chronic condition for students and it influences their academic performance and their quality of life. The diagnostic methods and the practice guidelines for asthma control are useful for preventing and controlling asthma. These findings provide indications of interventions are being used for the control of asthma in Canada.
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Affiliation(s)
- Frank Mo
- Centre for Chronic Disease Prevention and Control, Population and Public Health Branch, Health Canada, 120 Colonnade Road, Ottawa, Ontario, Canada K1A 0K9.
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Gibson PG, Powell H. Written action plans for asthma: an evidence-based review of the key components. Thorax 2004; 59:94-9. [PMID: 14760143 PMCID: PMC1746945 DOI: 10.1136/thorax.2003.011858] [Citation(s) in RCA: 254] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Written action plans for asthma facilitate the early detection and treatment of an asthma exacerbation. Several versions of action plans have been published but the key components have not been determined. A study was undertaken to determine the impact of individual components of written action plans on asthma health outcomes. METHODS Randomised controlled trials (n=26) that evaluated asthma action plans as part of asthma self-management education were identified. Action plans were classified as being individualised and complete if they specified when and how to increase treatment (n=17), and as incomplete (n=4) or non-specific (n=5) if they did not include these instructions. RESULTS For individualised complete written action plans the use of 2-4 action points and the use of both inhaled (ICS) and oral (OCS) corticosteroid consistently improved asthma outcomes. Action points based on personal best peak expiratory flow (PEF) consistently improved health outcomes while those based on percentage predicted PEF did not. The efficacy of incomplete action plans was inconclusive because of insufficient data. Non-specific action plans led to improvements in knowledge and symptoms. CONCLUSION Individualised written action plans based on personal best PEF, using 2-4 action points, and recommending both ICS and OCS for treatment of exacerbations consistently improve asthma health outcomes. Other variations appear less beneficial or require further study. These observations provide a guide to the types of variations possible with written action plans, and strongly support the use of individualised complete written action plans.
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Affiliation(s)
- P G Gibson
- Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia.
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Goeman DP, Aroni RA, Sawyer SM, Stewart K, Thien FCK, Abramson MJ, Douglass JA. Back for more: a qualitative study of emergency department reattendance for asthma. Med J Aust 2004; 180:113-7. [PMID: 14748672 DOI: 10.5694/j.1326-5377.2004.tb05831.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2003] [Accepted: 10/20/2003] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the reasons why individuals recurrently present with asthma to hospital emergency departments. DESIGN A predominantly qualitative study in which participants were interviewed in-depth about their asthma. Data on medication use, respiratory health and asthma knowledge were also collected, and asthma severity was determined from medical records. SETTING A tertiary teaching hospital and a suburban hospital emergency department (ED) from 1 March to 30 April 2000, and a rural hospital ED from 1 July to 31 August 2000. PARTICIPANTS The participation rate was 32% of an initial 195 ED attendees (183 of whom were eligible) aged 18-70 years: 32 had presented to an ED for asthma care on more than one occasion over the preceding 12 months (reattendees), and 29 were non-reattendees. RESULTS Two-thirds (22/32) of reattendees had chronic severe asthma and presentation to ED was deemed appropriate for 18 of these, indicated by recurrent severe asthma attacks despite seeking prior medical intervention. Reasons for re-presentation identified in a third of all reattendees included poor asthma knowledge, and financial and other barriers to medication use. CONCLUSIONS We identified potentially preventable issues in about a third of patients (most of whom had mild to moderate asthma) who recurrently presented to EDs for treatment. The remainder of the participants sought emergency asthma treatment appropriately after failing to respond to medical care, and this was frequently in accordance with their asthma management plans.
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Affiliation(s)
- Dianne P Goeman
- Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, VIC
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Walters EH, Walters JAE, Wood-Baker R. Why have asthma action plans failed the consumer test? Med J Aust 2003; 178:477-8. [PMID: 12741929 DOI: 10.5694/j.1326-5377.2003.tb05317.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2003] [Accepted: 04/03/2003] [Indexed: 11/17/2022]
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