June 2007

Patient-centred Health Care Resource

NAC welcomes Judi Wicking

A-Team Asthma Action

Asthma links

Birth order - is it important for asthma?

2008 NHMRC NICS Fellowship - reminder

Research Funding Opportunities 

Conference Diary 2007

Patient-centred Health Care Resource

Practical ways to incorporate the principles of patient-centred health care into every day practice are the focus of a new discussion paper published this month by the National Asthma Council Australia.

The paper, Patient-centred health care in primary care: an overview, will be of particular interest to general practitioners, allied health professionals and community pharmacists.

It highlights the principles of patient-centred health care and provides practical examples of how primary care professionals can make a difference by enhancing their patient-centred focus. Each example is supported with real patient case studies.

The paper has relevance to all primary health care patients and is not restricted to asthma.

Assoc Prof Ron Tomlins, general practitioner, Adjunct Associate Professor, Discipline of General Practice, Western Clinical School, Westmead, University of Sydney and past Chair, National Asthma Council Australia, was a member of the multi-disciplinary expert working committee responsible for developing the discussion paper.

He hopes the paper will prompt health professionals to think about things they may need to do differently to achieve a better outcome with some patients.

He said: “One thing that becomes obvious as we move towards evidence-based decision making for treatment is that there are still failures. It’s not that the health professional isn’t getting it right. The advice given to the patient could be aligned with the evidence and the best management approach may be being used, but sometimes the patient just doesn’t get better.

“There may be a whole lot of reasons, but there is also a possibility that the patient’s view of their health, and what they want out of life, could be different from what their doctor advises - a common dichotomy.

“This is when a patient-centred health care approach, where the patient is engaged and involved in determining their treatment, can be more effective than the text book approach to what is going on,” Assoc Prof Tomlins said.

“This new resource will give practitioners deep insights into the principles of patient-centred health care and solid examples of how this approach can positively impact patient care.”

The paper stems from an across-sector workshop convened by the National Asthma Council Australia in November 2005, which explored how the health system might be adapted to better suit the needs of patients.

Workshop participants recognised that all health professionals can, and should, ensure they are responsive to patients’ needs and the National Asthma Council Australia made a commitment to develop an evidence-based resource to further drive the integration of patient-centred health care principles and practice.

The discussion paper was funded by an independent educational grant from Pfizer Australia. It is a web-based resource.

The report of proceedings from the original Patient-Centred Health Care Workshop, November 2005, is also available.

Resources

Patient-centred health care in primary care: an overview

Report of Proceedings

NAC welcomes Judi Wicking

Judi Wicking joined the National Asthma Council Australia in May as the Project Officer for the GP and Allied Health Professional Asthma Education Program, taking over from Bernadette Flanagan.

Judi is an award-winning asthma educator and published researcher with an interest in how asthma educators working collaboratively with GPs can help patients with chronic respiratory health needs.

After starting her career as a practice nurse, Judi’s subsequent employment has included working as a respiratory research nurse with Monash University and the Alfred Hospital, and developing the Asthma Clinics in General Practice Program with the Whitehorse Division of General Practice. She is also on the Steering Committee for the Spirometry in General Practice research project.

Judi extended her nursing education by completing her Graduate Certificate in Asthma Education through Charles Sturt University, NSW, in 2003. She is working toward completing her Graduate Diploma and being a Credentialed Asthma Educator through the Australian Asthma & Respiratory Educators Association (AAREA).

As an active NAC A-Team presenter and current board member of AAREA, Judi is well aware of the continued need to promote best practice guidelines for asthma management to all health professionals across Australia.

The NAC is delighted to welcome her on board.

As Project Officer, Judi will coordinate asthma education workshops (A-Teams) and spirometry workshops for GPs and allied health professionals across Australia. She has already been involved in the development of new resources and support for presenters.

A-Team Asthma Action

The NAC is calling for expressions of interest from:

• Divisions wishing to run Asthma Education workshops and

• GPs and asthma educators interested in joining the A-Team.

The NAC’s “A Team”– a group of trained asthma experts – regularly runs asthma education workshops for GPs, practice nurses, asthma educators and other health professionals.

Hosted by Divisions of General Practice, the highly rated workshops are held in all States and Territories across Australia.

The current series of workshops focuses on the Asthma Cycle of Care (the former Asthma 3+ Visit Plan). Each session also covers 2–3 additional asthma topics chosen by the particular Division from the A-Team education modules. The modules include spirometry, medications, allergy, paediatric and older adult asthma, device technique and COPD.

The A-Team has already run several workshops in 2007, with locations ranging from suburban Adelaide to remote Kununurra in WA. More than 50% of the workshops in the current series will be held in rural or remote areas.

The A-Team usually presents as a team of one doctor (GP or respiratory physician) and one asthma educator, with all presentation material provided by the NAC. The NAC covers the costs of the presenters. Funding is available to assist Divisions with costs of running the event. For more information, please contact Judi Wicking at the NAC.

Resource

A-Team™ Asthma Education

Asthma links

Research published in Chest this month indicates that children who receive antibiotics before their first birthday are significantly more likely to develop asthma by the age of 7 years.¹ This recent study reports that children receiving antibiotics in the first year of life were at greater risk for developing asthma by the age of 7 years than those not receiving antibiotics. The risk for asthma doubled in children receiving antibiotics for non-respiratory infections, as well as in children who received multiple antibiotic courses and who did not live with a dog during the first year.

“Antibiotics are prescribed mostly for respiratory tract infections, yet respiratory symptoms can be a sign of future asthma. This may make it difficult to attribute antibiotic use to asthma development,” said lead study author Anita Kozyrskyj, PhD, University of Manitoba, Winnipeg, MB. “Our study reported on antibiotic use in children being treated for non-respiratory tract infections, which distinguishes the effect of the antibiotic.”

By using a prescription database, Dr. Kozyrskyj and colleagues from the University of Manitoba and McGill University in Montreal were able to monitor the antibiotic use of 13,116 children from birth to age 7 years, specifically noting antibiotic use during the first year of life and presence of asthma at 7 years. The reason for antibiotic use was categorised by lower respiratory tract infection (bronchitis, pneumonia), upper respiratory tract infection (otitis media, sinusitis), and non-respiratory tract infection (urinary infections, impetigo).

Risk and protective factors also were noted, including gender, urban or rural location, neighbourhood income, number of siblings at age 7 years, maternal history of asthma, and pets reported living in the home. Within the study group, six percent of children had current asthma at age 7 years, while 65 percent of children had received at least one antibiotic prescription during the first year of life. Of the prescriptions,

• 40 percent of children received antibiotics for otitis media,

• 28 percent for other upper respiratory tract infections,

• 19 percent for lower respiratory tract infections, and

• 7 percent for non-respiratory tract infections.

Results showed that antibiotic use in the first year was significantly associated with greater odds of asthma at age 7 years. This likelihood increased with the number of antibiotic courses, with children receiving more than four courses of antibiotics having 1.5 times the risk of asthma compared with children not receiving antibiotics. When researchers compared the reason for antibiotic use, their analysis indicated that asthma at age 7 years was almost twice as likely in children receiving an antibiotic for non-respiratory tract infections compared with children who did not receive antibiotics.

Maternal asthma and presence of a dog during the first year of life were both associated with asthma risk. Children who received multiple antibiotic courses and who were born to women without a history of asthma were twice as likely to develop asthma than those not receiving antibiotics. Furthermore, absence of a dog during the birth-year doubled asthma risk among children taking multiple courses of antibiotics.

“Dogs bring germs into the home, and it is thought that this exposure is required for the infant's immune system to develop normally. Other research has shown that the presence of a dog in early life protects against the development of asthma,” said Dr. Kozyrskyj. “Exposure to germs is lower in the absence of a dog. The administration of an antibiotic may further reduce this exposure and increase the likelihood of asthma development.”

Asthma prevention

The Asthma Management Handbook 2006 has a chapter discussing asthma prevention and includes the section 'Does allergen avoidance reduce asthma risk?'.² 

References

1. Kozyrskyj AL, Ernst P, Becker AB. Increased risk of childhood asthma from antibiotic use in early life. Chest. 2007 Jun;131(6):1753-9. (Abstract online)

2. Asthma Management Handbook 2006

Birth order - is it important for asthma?

A recent study, also published in Chest, challenges an old theory known as the “hygiene hypothesis,” which suggests that older children protect their younger siblings from developing asthma.³

To test this theory, researchers from Israel gathered and reviewed the medical records of 531,116 military draftees and assessed the prevalence of asthma in both the number of children per family and the birth order. Results showed that asthma prevalence was inversely related to the number of children in a family but only in families of four or more children.

 Also, birth order had no effect on asthma prevalence. Researchers concluded that these results conflict with the ‘hygiene hypothesis.’

Reference

Goldberg S, Israeli E, Schwartz S, Shochat T, Izbicki G, Toker-Maimon O, Klement E, Picard E. Asthma prevalence, family size, and birth order. Chest. 2007 Jun;131(6):1747-52 (Abstract online)

2008 NHMRC National Institute of Clinical Studies Fellowship - reminder

The National Health and Medical Research Council (NHMRC) is inviting early-to-mid career health professionals with a keen commitment to improving health care in Australia to apply for a 2008 NHMRC National Institute of Clinical Studies Fellowship (NICS). NICS is an institute within the NHMRC and works to improve healthcare by getting health and medical research into practice.

Established in 2003, the NHMRC’s NICS Fellowship Program identifies and supports health professionals who are future leaders in evidence-based health care to address an evidence-practice gap in clinical practice.

The two year, half-time Fellowships provide health professionals with mentoring, training, national and international networking and practical support to ensure their success.

For more information see www.nhmrc.gov.au/nics and the 2008 Fellowship Program

Please check individual Fellowship details for online application closing dates.

Research Funding Opportunities