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Explore research from IPCRG 2020 Virtual Conference presenters

As the official journal of International Primary Care Respiratory Group, npj Primary Care Respiratory Medicine is pleased to share published research by many of the presenters of IPCRG's 2020 Virtual Conference Sessions. The collection includes articles on the diagnosis and management of asthma, COPD, patient education in primary care and more, and features work from:

  • Professor Jaime Correia de Sousa, University of Minho, Braga, Portugal
  • Dr. Hanna Sandelowsky, Karolinska Institute, Stockholm, Sweden
  • Dr. Alan Kaplan, University of Toronto, Canada
  • Dr. Luke Daines, The University of Edinburgh, UK
  • Professor James Stout, University of Washington, Seattle, WA, USA
  • Dr. Vincent Mak, Imperial College Healthcare Trust, London, UK
  • Professor Hilary Pinnock, The University of Edinburgh, UK
  • Dr. Noel Baxter, Southwark Clinical Commissioning Group, London, UK
  • Dr. Sundeep Salvi, Chest Research Foundation, Pune, India

Diagnosis and management of asthma

Currently available computer decision support systems (CDSSs) contribute little to improving clinical outcomes for people with asthma. CDSSs are interactive systems that are designed to assist physicians and other health professionals in making clinical decisions. As part of a systematic review, Susannah McLean and colleagues at the University of Edinburgh searched major bibliographic databases (Medline, Embase, Health Technology Assessment, Cochrane and Inspec) and online repositories for published reports, ongoing studies and unpublished trials on the use of CDSSs in the professional management of asthma. They found that CDSSs were generally ineffective for two reasons: the systems were rarely used and their advice was not followed. When used properly, however, CDSSs did provide some benefits. Future CDSSs must therefore align with professional workflow if they are to improve clinical outcomes.

Article | Open Access | | npj Primary Care Respiratory Medicine

A programme to help doctors and patients control difficult-to-manage asthma has been adapted for local use in the Netherlands. It is important to distinguish between truly severe asthma (about 4% of Dutch patients) and so-called difficult-to-manage asthma (about 17%) so that expensive life-saving treatments can be allocated effectively. Persijn Honkoop at Leiden University and co-workers have adapted an internationally-recognised plan, first developed in the UK, for the specific context of the Netherlands. The researchers surveyed professionals and patients, asking them to suggest and rank items they deemed important for a difficult-to-manage asthma programme. The participants generally agreed that patient-specific and behavioural factors were crucial to good diagnosis and care. The researchers have used their findings to develop an accessible training scheme which could help reduce the numbers of patients that are unnecessarily referred to hospital.

Article | Open Access | | npj Primary Care Respiratory Medicine

Asthma: Attitude Counts! The management of asthma in Asia should not only be tailored to patients’ symptoms but also to their attitudes towards healthcare and their disease. A multidisciplinary team, led by Alison Chisholm of the Respiratory Effectiveness Group (Cambridge, UK), used a consensus-building research technique to develop a series of recommendations tailored to the disease profiles and healthcare attitudes of adult asthma patients living in Asia. The work provides practical management guidance to clinicians following an earlier study of asthma burden within Asia that identified five patient groups distinct in terms of their control profile and health attitudes. The multidisciplinary experts agreed there is no one-size-fits-all approach to managing asthma; the best approach is one that considers and strikes the right balance between treatment efficacy and patient preference.

Article | Open Access | | npj Primary Care Respiratory Medicine

COPD

A trial to improve care for patients with severe lung disease concludes that holistic treatment throughout the disease may be beneficial. Severe chronic obstructive pulmonary disease (COPD) has a massive physical and psychological impact on patients’ lives, prompting calls for palliative care provision. In a pilot trial of elderly patients with very severe COPD, Hilary Pinnock and co-workers at the University of Edinburgh, Scotland, investigated the effectiveness of supportive home visits by a specialist respiratory nurse, who assessed patients’ wellbeing and needs, and agreed upon a plan of action with them. Qualitative interviews with patients and professionals indicated that the holistic assessment was well received and appreciated. However, few actions resulted from the nurse’s intervention, partly due to overlaps with existing care. The team believes integrating holistic assessment into routine COPD treatment may be more appropriate.

Article | Open Access | | npj Primary Care Respiratory Medicine

Public education in primary care

Understanding the routines of primary care practices can suggest strategies to implement supported self-management in general practice. Supported self-management of asthma including provision of individual action plans improves patient health and reduces the burden on healthcare services, but is not well implemented in routine practice. As part of a large-scale programme to implement self-management into UK general practice, Hilary Pinnock at the University of Edinburgh and co-workers conducted interviews and focus groups with 33 participants from 14 general practices to explore the organisational routines that hinder or enable professionals to provide support asthma self-management. Poor attendance at asthma clinics, demarcation of roles, lack of time and limited access to tailored resources were identified as specific barriers. Improvements suggested included improved teamwork between doctors and other medical healthcare professionals, comprehensive training, and improvements to IT systems.

Article | Open Access | | npj Primary Care Respiratory Medicine

Other articles by conference presenters

A simple questionnaire and peak flow meter measurements can help doctors differentiate between asthma and chronic lung disease. In clinical settings where access to specialist equipment and knowledge is limited, it can be challenging for doctors to tell the difference between asthma and chronic obstructive pulmonary disease (COPD). To determine a viable alternative method for differentiating between these diseases, Rahul Kodgule and colleagues at the Chest Research Foundation in Pune, India, trialed a simplified version of two existing symptom questionnaires, combined with peak flow meter measurements. They assessed 189 patients using this method, and found it aided diagnosis with high sensitivity and specificity. Breathlessness, cough and wheeze were the minimal symptoms required for COPD diagnosis, while the length of asymptomatic periods was most helpful in distinguishing asthma from COPD.

Article | Open Access | | npj Primary Care Respiratory Medicine

Effective management of international primary care data sharing shows great potential to inform clinical practice for multiple diseases. The International Primary Care Research Group (IPCRG) was established in 2000 to progress sharing of big data between countries and support associated research projects. Liza Cragg of IPCRG in the UK and co-workers, reported on progress and limitations faced by one research group, UNLOCK, who are investigating the long-term impacts of chronic lung diseases. Cragg’s team interviewed UNLOCK members and analyzed results of individual research studies undertaken between 2010 and 2016. Constraints highlighted by researchers included inconsistencies across datasets, ethical concerns about data use, difficulties organizing international working groups and the voluntary nature of IPRCG work. Progress was slower than anticipated but several successful studies highlighted the potential for primary care data sharing to provide valuable insights.

Article | Open Access | | npj Primary Care Respiratory Medicine

Doctors in India require better access to affordable equipment in diagnosing chronic lung diseases, say researchers. Spirometry is a simple machine-based test that measures lung function, and is highly regarded for diagnosing and determining the severity of lung diseases. Nitin Vanjare at the Chest Research Foundation in Pune, India, and co-workers conducted two nationwide surveys in 2005 and 2013 to determine the use of spirometry by physicians in different care settings in the country. The researchers found that spirometry use increased in all sectors, with chest physicians making the most use of the test. However, family doctors and pediatricians, usually the first port of call for patients, rarely used spirometry. Physicians cited expensive equipment, uncertainty in interpreting results and not having time to conduct tests as key reasons for spirometry underuse.

Article | Open Access | | npj Primary Care Respiratory Medicine

A patient questionnaire aimed at enhancing asthma management has been translated from English and verified as suitable for use in Portugal. Pedro Teixeira at the University of Minho, alongside scientists across Portugal, tested the validity of using the modified Patient Enablement Instrument (mPEI) both in translation and in a different culture from its original intended setting. The mPEI is a simple questionnaire from the UK that measures patients' ability to control their asthma, and encourages heightened awareness of asthma management. While mPEI has already been used in Portugal in translation, the researchers wanted to determine the tool's reliability and content validity for their country. They freshly translated mPEI and administered it to 142 patients with persistent asthma. Their new Portuguese translation exhibited good correspondence with the original test, strong internal consistency and cross-cultural validity.

Article | Open Access | | npj Primary Care Respiratory Medicine

Collaborative care could improve management of asthma and chronic obstructive pulmonary disease (COPD). To maximize resources available for asthma and COPD care, Sonia Martins, Rafael Stelmach and colleagues, of the Respiratory Group of Brazilian Society of Family Medicine and Community and University of São Paulo in Brazil, implemented a collaborative care model in three of the nine health territories in the city of São Bernardo do Campo in southeastern Brazil. Family doctors, nurses and healthcare managers attended an eight-hour workshop led by three pulmonologists and one primary care physician to raise professional awareness of the two conditions. Primary care physicians then conducted joint consultations with pulmonologists on patients, followed by individual case discussions without patients. The approach was effective in improving the knowledge and confidence of primary care professionals in managing asthma and COPD. It also decreased the number of referrals to specialists.

Article | Open Access | | npj Primary Care Respiratory Medicine