In this Issue August 2002

Journalism Awards - closing date approaching

And if that's not enough, it also makes you cranky!

Asthma Adherence

Adherence issues are not confined to asthma. With acute phases to a chronic illness, asthma presents some special challenges for addressing adherence. Better medications and more lifestyle information do not necessarily lead to better management of asthma for the patient. However better communication from the doctor, pharmacist, asthma educator, and nurse can have a positive impact on patient adherence as the "Asthma Adherence - A Guide for Health Professionals" explains.

The guide is based on the belief that the health professional has a vital role to play in improving asthma adherence, and that we need to foster relationships with patients if we are to successfully combat non-adherence.

Research supports that adopting a more interactive, non-judgmental and patient-centred approach will help to establish a more open relationship with the person with asthma and help better identify possible barriers to adherence.

The evolution of the role of the health professional in asthma management from instructor to partner can be seen in the changing terminology:

compliance --> adherence --> concordance

Compliance implies that the patient will follow doctor's orders, is in a less informed position and has little or no input into their management strategy.

Adherence focuses more on commitment to the regimen where the therapy is the controlling factor. There is at least reasonable negotiation between members of the asthma care team and the person with asthma.

Concordance is based on a notion of equality and respect for the patient and their autonomy, the desired relationship in a therapeutic alliance between the care team and person with asthma.

The term adherence is used in the guide more to coincide with literature and practitioner comfort while the notion of concordance is the ultimate aim.

Poor adherence is nothing new. Around 200 BC, Hippocrates advised the physician,

'...to be alert to the faults of the patients which make them lie about their taking of the medicines prescribed and when things go wrong, refuse to confess that they have not been taking their medicine.'

In a dynamic and complex process adherence goes beyond the correct use of prescribed medication. Using an evidence-based approach the guide covers the adherence influences and some positive strategies for dealing with patient issues in three main sections. Some excerpts from the sections are shown below.

Section I - 'what do we mean by adherence?'

There are several types of non-adherence, as well as degrees or levels of adherence. Researchers have developed the following categories of non-adherence:

Primary - when the patient does not get the prescription filled or fails to attend an appointment

Secondary - when the treatment is not taken as prescribed

Intentional - when the patient rejects the diagnosis or treatment

Section 2 - 'influences on adherence'

'...the best drug in the world is only as good as it is able to be correctly used.'

(Sawyer 1998)

Older people also have many unique factors influencing their adherence. Some studies have indicated that 25-50% of particular groups of elderly patients do not, or cannot, take all their medications as prescribed (Shimp 1985).

Older people are more susceptible to adverse reactions to medications, which discourage adherence (Williamson 1980).

The issue of drug interactions can also increase the incidence of fear amongst the elderly about the amount of medication they take. Also, 20% of those over 85 years of age have poor vision.

Other factors to take into account include: strength and motor coordination; cognition (the incidence of dementia is expected to go up vastly over the next 20 years); depression and isolation.

Older people also tend to underreport their symptoms. The presence of other diseases (such as heart disease) makes asthma symptoms more difficult to identify (Yates 1997).

Section 3 - 'how to improve adherence'.

Strategies

Develop open, communicative, non-judgmental relationships with patients
Normalise poor adherence in dealings with your patient
Adopt a partnership approach to asthma management with your patient
Involve your patient in the planning process
Simplify treatment where possible, and strive to tailor treatment plans to your patient's preferences, needs and capabilities
Ensure that your patient understands their asthma and treatment.

Practical Suggestions

Use appropriate information-gathering skills

It is possible to facilitate better communication with your patients by:

using skills such as open-ended questions at the beginning of the consultation
avoiding questions that elicit a yes/no response or that are judgmental in their tone
showing empathy and warmth and following up on the patient's verbal clues.

Facilitate open discussions with your patient about adherence

Your attitude and your manner will help your patient to be honest and realistic when you are discussing adherence to different treatments for asthma. It is important to be non-judgmental and to normalise poor adherence (remember, around 50% of patients don't adhere to prescribed therapy).
Ask questions that will elicit information about the patient's health beliefs, their attitude to their diagnosis and their willingness to make behaviour changes in order to better manage their asthma (see tips).

Use reminders

A number of prompts and reminders have been demonstrated to improve adherence:

telephone or postcard reminders
individualised reminder charts
diaries
engaging family members and carers to provide reminders......

Along with a substantial list of frequently asked questions, important tools such as a questionnaire and behaviour change protocol are provided to assist in assessing and addressing the issue of adherence.

The past ten years have seen a more collaborative team approach to patient care, and asthma management is no exception. General practitioners, pharmacists, asthma educators and nurses all have vital roles and responsibilities in improving patient adherence and asthma management.

For the full resource go to Asthma Adherence - A Guide for Health Professionals

Disease Management Conference

A conference concentrating on improving coordination in service delivery to ensure quality of care to those with chronic and complex illnesses is taking place in Sydney 14 - 16 October 2002, at the Millennium Hotel.

National health priorities of asthma, diabetes and cardiovascular disease feature in how best to coordinate health care delivery through government, GPs, Hospitals, pathology, community health and the pharmaceutical industry working together.

Ten practical case studies will be presented from

Department of Health & Ageing
Western Sydney Area Health Service
Victorian Centre for Ambulatory Care Innovation (VCACI)
Consumers' Health Forum of Australia
UNSW
Medicines Australia (formerly known as the APMA)
Royal Prince Alfred Hospital
National Asthma Council
Asthma NSW
International Diabetes Institute

to highlight that through better detection of conditions and better monitoring of high risk patients, complex chronic illnesses can be better managed and prevention strategies better implemented.

Topics to be covered include:

The importance for consumers to be educated about their own disease and be involved in self-management.
How best to combine complementary health care with prescription medicines.
How involved are pharmaceutical companies with population health issues?
How to prevent Type 2 diabetes?
Having the right infrastructure and IT decision support tools to capture clinical information for evidence based practice.

There is also an interactive full day workshop October 16 2002 on 'Evidence-based Medicine and Decision Support Tools' for monitoring and controlling disease management.

Journalism Awards - closing date approaching

Just a reminder that entries for the National Asthma Council Journalism Awards close by last mail or close of business (5pm) August 30.

Through the awards for stories appearing from November 2001 through to August 2002, the NAC aims to promote and encourage responsible reporting of issues relating to asthma treatment, management and education.

Accurate, honest and responsible medical reporting is of utmost importance for many people with asthma as it is a major source of medical information. Bringing issues out into the open can also lead to identifying 'hidden' patients and getting treatment to those who need it most.

A broad range of reporting styles are acceptable including news, features and documentary. Entries are only open to journalists in Australia. Individuals can nominate themselves or be nominated by an employer or colleague.

And if that is not enough, it also makes you cranky!

Asthma and smoking is simply not sensible. Most smokers, even those without asthma, can give you ten good reasons to quit. Action on Smoking and Health (ASH) aims to continually add to those ten good reasons. Another aim for ASH is keeping health professionals up to date in the campaign to reduce smoking rates in Australia to 15% or less before 2010.

In their on-line publication 'Smoke Signals' ASH will keep you in touch with the latest issues and developments in tobacco control including this recent finding.

New research from the UK shows that not only does smoking threaten your life and health in the longer term, it also makes even light smokers cranky and incompetent.

A study from King's College, London, just published, assessed the moods of light smokers (5-12 cigarettes a day) immediately after one of their usual puff breaks.

Far from relaxed or calmed by their cigarette, the smokers felt "significantly more discontented, troubled, tense, quarrelsome, furious, impatient, hostile, annoyed and disgusted and experienced greater dizziness," as well as "incompetent, dizzy and sweating" than the non-smoking control group, says the study report.

For the full story on 'cranky' smokers

For access to ASH 'Smoke Signals' newsletter

HealthInsite

As Australians continue to increasingly turn to the Internet as a source of health information, finding a clear path to credible, relevant and reliable web sites can often be a challenge. As a health professional, knowing whether a site conforms with important attributes such as

Completeness of information;
Accuracy of information;
Having no conflicting information; and;
Readability

is not an easy task.

A way to ensure access to credible sites for patients is to recommend a trusted portal such as HealthInsite, a Commonwealth Government initiative established in 2000.

HealthInsite aims to provide easy access to quality health information relevant to Australians. Importantly, the National Asthma Council has been an Asthma Content partner since HealthInsite's inception.

The six national health priorities of cardiovascular health, cancer control, injury prevention and control, mental health, diabetes mellitus and asthma, as well as many other conditions, are covered on the site.

The organisations and websites whose content has been proposed for access through HealthInsite undergo a special assessment process and must be approved by a qualified editorial board.

For access to HealthInsite