In
this Issue April 2004
World Asthma Day, May 4
National Asthma Council Contact Update
Virtual Roadshow - Treating Kids with Asthma -
getting it right!
General Practice & Primary Health Care Research
Conference
More From IPCRG 2nd World Conference
Home Medicines Review (HMR) - A Vital Tool In
Patient Management
Conference Diary 2004
World Asthma Day - May 4, 2004
Australia continues to lead the way in asthma management and
education, according to an international study titled
‘The Global Burden of Asthma’. The study reveals that the
education and management programs developed and put into action by the National
Asthma Council, Asthma Foundations of Australia and other Australian
organisations in asthma have proven effective and can be adapted by other
countries.
| Asthma is estimated to affect as many as 300 million people
worldwide—a number that could increase by a further 100 to 150
million by 2025. |
By world standards, Australia has made considerable progress in
improving the standards of asthma care, raising public awareness, achieving
Government recognition and improving the way people manage their own asthma.
Further good news is that two recent studies indicate that the prevalence of
asthma in children may now be declining in Australia for the first time since
the 1980s.
The report notes that the Australian Government’s
acknowledgment of asthma as a National Health Priority is an important component
in this process. The funding and recognition provided by the Australian
Government, through the Department of Health and Ageing, has enabled very
important initiatives to occur including the GP intervention, the Asthma 3+
Visit Plan, developed by the National Asthma Council and the Asthma Friendly
Schools program conducted by the Asthma Foundations.
For more on World Asthma Day go to:-
Australia leads
the way toward better asthma management
Useful Resources
The Global Burden of Asthma Report (Summary)
(http://207.159.65.33/wadsetup/materials_04/boa_sum.pdf)
(PDF File,
Acrobat Reader Required)
Asthma 3+ Visit Plan
(http://www.nationalasthma.org.au/publications/3plusplan/3plus_rev.html)
Asthma Foundations of Australia
(http://www.asthmaaustralia.org.au)
Virtual Roadshow - Treating kids with asthma
- getting it right!
Around
Australia from far North Queensland to Tasmania general practitioners,
pharmacists, nurses and asthma educators logged on to the National Asthma
Council's interactive Virtual Roadshow, "Treating kids with asthma – getting it
right!", conducted on Wednesday 21 April.
The Virtual Roadshow provides flexible continuing education for
health professionals with live participation by groups or individuals. A
three-month window of opportunity also exists to view or review the program and
still qualify for points.
Dr Ron Tomlins, Chairman, National Asthma Council introduced the
presentations and Q & A discussions by expert panellists Prof. Nicholas Glasgow
(Director, Australian Primary Care Health Research Institute, the Australian
National University, Canberra), Dr Dominic Fitzgerald (Paediatric respiratory
and sleep physician, Deputy Head of the Division of Academic and General
Medicine at the Children’s Hospital, Westmead, Sydney) and Dr Amanda Barnard
(General Practitioner, Claremont, Western Australia, Senior Lecturer, Department
of General Practice, University of Western Australia).
A wide range of health professional disciplines viewed the
Roadshow live. This produced over 60 interesting and challenging questions for
the panel to address. Answers to just some of the questions posed live and
during three days that the panellists were available include:
Should skin test for allergens or RAST test be preferred to identify
the cause of the child's asthma? |
Skin tests assess skin reactivity to common
aeroallergens. Positive tests indicate atopy. The RAST test assess
reactivity to aeroallergens by measuring reactions of blood. Positive
tests indicate atopy. The tests are equivalent, but the skin test is
less invasive. Neither test identifies the cause of asthma.
Answered By Prof. Nicholas Glasgow
|
What's the symptom controller for asthma in children? What's the
difference in designing an asthma action plan between a young child and
an adult? |
Symptom controllers is the original term for
long acting beta agonists. Now, because of combination meds eg Symbicort
and Seretide, this is probably obsolete as people do not use long acting
beta agonists without ICS for people with asthma. Secondly, the plans
are not greatly different and the principals are similar.
Answered By Dr. Dominic Fitzgerald
For Asthma Action Plans go to
|
| Not a question - thanks
for this roadshow; as a pharmacist I encourage doctors noting on scripts
for pharmacists to demonstrate devices, check inhaler use etc - this is
such an important part of the overall management.
|
We would all support this- the bottom third of
the electronic scripts can easily be utilised for this sort of
communication.
Answered By Dr. Amanda Barnard
|
| Do we have to give kids
with infrequent asthma preventer during winter? |
If it is really infrequent episodic asthma
during winter - episodes more than 6-8 weeks apart and with no interval
symptoms, then there is no need for a preventer. If it is frequent
episodic asthma- shorter interval and minimal symptoms between - then a
preventer is indicated. There may be seasonal variation in the pattern
of asthma. Many children with frequent episodic or mild persistent
asthma only need preventers for part of the year.
Answered By Dr. Amanda Barnard
|
Thanks for the great
update. My questions pertain to management of SE disadvantaged
Aboriginal clients in remote Australia. Cost of spacer devices is a huge
barrier to treatment. Nebulisers are still used in the clinic setting
and will continue to be used. Some workers have adopted innovative ways
to deliver Ventolin using plastic 390 ml drink bottles (sterilised etc)
that clients can use because they cannot afford devices.
Do you
know if this cheap alternative been evaluated?
How can the NAC assist in addressing this critical issue of
accessing devices?
If delivery devices cannot be accessed- is
it valid to continue to use Ventolin syrup in young children? |
For many of our patients, treatment costs may
limit the quality of the outcome that can be achieved. In general, there
is little support for the use of Ventolin syrup compared with other
delivery modalities.
I understand that PBAC is looking at the
possibility of including spacer devices on the PBS.
In South
Africa, Heather Zar and her associates have shown that plastic soft
drink bottles can be effective low cost options for spacers. Inhaled
therapy using a metered-dose inhaler (MDI) with attached spacer has been
increasingly recognized as the optimal method for delivering asthma
medication for acute attacks and chronic prophylaxis. However, in
developing countries the cost and availability of commercially produced
spacers limit the use of MDI-spacer delivery systems.
A 500-ml
plastic bottle has been recently adapted to function as a spacer. This
article reviews the current data on the efficacy of this bottle-spacer
and discusses its advantages and limitations. It is concluded that "a
modified 500-ml plastic bottle is an effective spacer; modification and
use of this device should be incorporated into international guidelines
for the management of children with asthma." (Zar HJ, Asmus MJ, Weinberg
EG in Pediatr Allergy Immunol. 2002 Jun;13(3):217-22)
Answered By Dr. Ron Tomlins
|
If you were unable to participate on the day or would like
to review all the issues raised by your peers, the presentation is available to
view or review until the end of July.
Simply go to
NAC Virtual Roadshow
General Practice & Primary Health Care
Research Conference
The
2004 GP & PHC Research Conference will be held at the Brisbane Sheraton Hotel,
Queensland on the 3rd and 4th June with pre-conference workshops to be held on
Wednesday 2nd June.
The conference is an annual forum for the
presentation of research and evaluation funded through GPEP, PHC RED, Divisions
of General Practice and other sources. It is a valuable opportunity for
delegates to meet, exchange ideas and explore general practice and primary
health care issues.
The 2004 program offers a challenging mix of plenary
sessions, international and Australian speakers, a “hypothetical”, poster and
paper presentation sessions and poster displays. Pre-conference workshops on 2
June provide opportunities for skill development, in-depth discussion and
networking.
"What’s [not] working? How do we know?" is the conference
theme and speakers will address points including:
-
How effectively is the PHC RED Strategy building research
and evaluation capacity?
-
How well are research and evaluation results influencing
policy and practice?
-
How does collaborative research improve relevance and
uptake?
-
What roles are Divisions playing in research and evaluation
in primary health care.
For more information and registration details go to
2004 GP & PHC
Research Conference
(http://www.phcris.org.au/events/conference_frameset.html)
More from IPCRG 2nd World Conference
Last month's Newsletter highlighted the IPCRG Keynote
presentation reviewing the SARS experience from Singapore. Bringing the
spotlight much closer to home for every health professional is the Home
Medicines Review (HMR) Keynote presentation.
The case study included
served to highlight some excellent points concerning age and poly- pharmacy for
patients. Associate Professor Ian Charlton (general practitioner), observed that
some twenty years ago he had one patient over the age of 90 years under his
care. Today he has nineteen such patients!
Indeed, Dr Charlton was generous in sharing his experience in
engaging the HMR process for one of his patients. His key point was that no
matter how well-managed a patient may appear, undertaking an HMR may reveal some
surprising results.
Points to Ponder
-
Multiple medications require good organisation and this can
be a challenge for older people. One possible solution is prepacking
individual doses using a Webster Pack or similar.
-
Keeping abreast of side effects that a patient may be
experiencing that could reduce quality of life.
-
Providing written Asthma Action Plans in large type or big
clear handwriting.
-
Providing oral instructions clearly, with written back up.
-
Being aware that some patients may have different living
arrangements. For example, a person may have a written Asthma Action Plan
suitable for city life. However, when that person goes to the bush, or
spends time at the beach away from their suburban residence within easy
access of pharmacy and emergency care, the written Asthma Action Plan may
need review for that specific situation.
-
Taking the opportunity to involve carers however formal or
informal the role may be.
With only 6% of general practitioners ordering HMRs, it is a
service that certainly requires consideration particularly for older patients
with asthma.
For more information go to
Home Medicines
Review
(http://www.health.gov.au/epc/dmmr.htm)
Keynote 9
Home Medicines Review (HMR) - A Vital Tool In
Patient Management
Gowan JA1 , Charlton I2, Hogan L3
1. Northern & Northeast Valley Divisions of General Practice;
2. General
Practitioner NSW;
3. Consultant Pharmacist and Asthma Educator, Sunbury
Victoria
Home Medicines Review (HMR) is a service to patients living at
home in the community. The goal of an HMR is to maximise an individual patient’s
benefit from their medication regimen, and prevent medication-related problems
through a team approach, involving the patient’s GP and preferred community
pharmacy, with the patient as the central focus. It may also involve other
relevant members of the healthcare team, such as nurses in community practice or
carers.
The HMR process utilises the specific knowledge and expertise of
each of the health care professionals involved. In collaboration with the GP, a
pharmacist comprehensively reviews the patient’s medication regimen in a home
visit.
After discussion of the visit findings and
report with the pharmacist, the GP and patient agree on a medication management
plan. The patient is central in the development and implementation of this plan
with their GP. The objectives of an HMR are to:
-
achieve safe, effective, and appropriate use of medications
by detecting and addressing medication-related problem/s that interfere with
desired patient outcomes;
-
improve the patient’s quality of life and health outcomes
using a best practice approach, that involves a collaborative effort between
the GP, pharmacist, other relevant health professionals and the patient (and
where appropriate, their carer);
-
improve the patient’s, and health professionals’, knowledge
and understanding about medications, and
-
facilitate cooperative working relationships between members
of the health care team, in the interests of patient health and well being.
The program was introduced in October 2001. At the end of
October 2003, nearly 36,000 HMRs had been completed and $5M remuneration claimed
by pharmacists and general practitioners from the Federal government.
After an introduction about the process, Assoc Prof Ian Charlton, General
Practitioner, Mrs Luisa Hogan, Consultant pharmacist and asthma educator, and Dr
Jenny Gowan, Consultant pharmacist and HMR Facilitator, discussed the success of
this new Australian initiative using case studies.
For more IPCRG Program Highlights go to
IPCRG
Melbourne 2004
(http://www.ipcrg-melbourne.org/news.htm#high)
Conference
Diary 2004
Submit brief conference/meeting details to the National Asthma
Council for possible posting in our Conference Diary by email to
nac@NationalAsthma.org.au.
|
General Practice & Primary Health Care Research
Conference
Brisbane Sheraton Hotel, Queensland
2-4 June, 2004
2004 GP & PHC Research Conference
|
 |
International Pediatric Respiratory, Allergy and
Immunology Congress.
Hong Kong Convention and Exhibition Centre
10-13 July 2004.
IPRAIC Hong Kong
(http://www.ipriac.org) |
 |
National Medicines Symposium 2004
Quality Use of
Medicines - Time for total integration
Brisbane Convention and
Exhibition Centre
Brisbane, Australia
28-30 July, 2004
National
Medicines Symposium 2004
|
 |
Created April 27, 2004. Updated
September 30, 2008
