Goal Three - Achieve Planned and Shared Responsibility For Asthma

Monitoring

Notes to Goal Three

This should include:

Integrated Patient Care

The best approach to asthma management in the community involves a team of health professionals working together across many settings. Patient care needs to be integrated by increasing consistent communication between professionals about the management of asthma in individuals and their families. The success of integrated care requires that people with asthma will have access to, and be able to afford, quality asthma management consistent with the standards set in the Asthma Management Plan.

Team Asthma Management

Appropriate therapeutic management requires that patients be actively involved in determining their asthma management plan. This should significantly improve the way they use medications and generally manage their asthma. Making the right choice for the individual may require that doctors and other health professionals adopt a range of health and behavioural interventions and strategies. These will be directed toward improving self-monitoring behaviour, encouraging collaborative management and increasing adherence to action plans and to preventive therapy.

Asthma Education

Health professionals, people with asthma, their carers and the general community need ongoing asthma education. All members of the asthma management team must have current information on asthma on a regular basis. Initial training courses and continuing education courses for health professionals must include asthma management. Targeted public health campaigns must be employed to reach all sections of the community to raise awareness of asthma and to convey the correct messages on asthma management to people with asthma and their carers.

Principal Strategies

Establish through education, practice and evaluation the attitude amongst the community, health professionals, carers and people with asthma that shared and planned responsibility and adherence to the Asthma Management Plan is the most effective approach to asthma management.

Increase the skills level of both health professionals and people with asthma to improve asthma management. This can happen as a result of developing, piloting and evaluating intervention and management. This includes improved means of communication, defining the minimum skills needed by service providers and consumers to effectively manage their asthma and providing best practice guidelines through the Asthma Management Plan.

Develop, evaluate and provide suitable tools to facilitate planned and improved education and communication between health professionals and people with asthma and their carers.

Conduct research to ascertain community attitudes and knowledge and to identify and address deficiencies in knowledge about asthma and in asthma management practices.

Identify and remove barriers which prevent people with asthma achieving optimal care.

Develop and implement asthma education programs and the optimal management of asthma, and promote evaluated interventions found to be effective.

Detailed Strategies

S3.1 Better communication between health professionals and people with asthma and their carers.

3.1.1 Facilitate regular discussion between doctors, pharmacists, asthma educators and people with asthma about best asthma management practices.

3.1.2 Establish better communications between professional groups, taking advantage of technological developments in communications.

3.1.3 Establish more asthma education positions in community and hospital settings.

3.1.4 Identify and communicate asthma management information in the most effective and appropriate manner to health professionals and consumers.

3.1.5 Ensure that all communications strategies cater for those of non English speaking background (NESB) and limited literacy skills.

S3.2 Continue to improve the content and availability of information about asthma in the media.

3.2.1 Conduct national community awareness campaigns to maintain public awareness of the seriousness of asthma and the need for asthma management, to stimulate patients to seek medical review.

3.2.2 Develop mass communication strategies targeted at specific sub-groups of asthmatics (e.g. adolescents, the elderly, recurrent A & E attendees) whose needs have been defined by research.

3.2.3 Undertake similar campaigns on a local basis during Asthma Week, and at other times, if possible.

3.2.4 Develop links with the media to ensure accurate coverage of asthma issues, provide media with state-of-the-art information on asthma.

3.2.5 Conduct media training for asthma spokespeople.

S3.3 Provide equitable access to medication and devices.

3.3.1 Ensure that asthma expertise is readily available.

3.3.2 Identify and redress deficiencies in particular community settings and rural communities. Issues to be addressed are:

- rural isolation
- ethnicity
- Aboriginality
- health literacy
- socio-economic status

3.2.3 Encourage the development of policies which ensure more equitable distribution of professional expertise and health care resources.

3.2.4 Investigate the cost implications and cost effectiveness of asthma devices and medication and the possible need for subsidies by government and/or health insurance companies.

Current Situation/Evidence	Performance Indicators
The NAC and other asthma initiatives appear to have contributed to high levels of asthma awareness in Australia, especially changing opinions about reliever medications and continuing to improve management practices among those with asthma¹.	An increase in community awareness of asthma and its significance.
Asthma management is still fragmented. Asthma education of nurses improves both knowledge and patient management. More interventions need to be trialed between other health Professionals and patients².	The establishment of communications/organisational systems across health and non-health sectors regarding asthma management.
Limited mechanisms for communication. The NAC's Asthma Liaison Officers in General Practice Divisions are the first step in improving communication. Asthma educators provide good links with doctors.	An improvement in liaison between hospitals, general practitioners, pharmacists, specialists and asthma educators.
For some, access to and availability of medication and devices is restricted by socioeconomic factors.	Improved access to aids for good asthma management, e.g. medication and devices.
Current communication is fragmented and poor³.	An improvement in communications between the hospital and health professionals in the community
21.7% of children⁴ and 19.8% of adults with asthma have a written action plan⁵.	An increase in the proportion of all people with asthma who have a written action plan.
Sub-optimal and variable numbers participating in management plan development.	An increase in the number of people who participate in the development of the written asthma management plan with their doctor.
Limited adherence to management plans^6,7 .	An increase in adherence to written asthma management plans by people with asthma.
Knowledge of and access to action plans currently unknown, but assumed to be less than 15% of all people with asthma.	An increase in the proportion of those with moderate or severe asthma who have access to their action
25% of people with persistent asthma have not had medical review within the last 12 months⁸.	An increase in the proportion with persistent asthma who visit their doctor for regular review.
Limited understanding of asthma attack⁹.	An increase in the early recognition of asthma attacks by people with asthma.
Anecdotal evidence suggests the carrying of a bronchodilator inhaler is variable depending on situation and social context, e.g. camp, school, swimming.	An increase in the proportion of people with moderate to severe asthma who always have a bronchodilator inhaler with them.
Sub-optimal assessment and treatment of acute asthma and defects in the implementation of the Asthma Management Plan^10,11,12.	An increase in the proportion of health professionals, hospitals, emergency departments and GPs who manage asthma in accordance with best practice guidelines.
Many asthma patients not provided with skills to manage future attacks of asthma¹³.	An increase in the proportion of people with asthma who, where appropriate, own and effectively use a flow meter.
More health professionals need asthma management education and many professional associations are currently addressing this¹⁴.	An increase in the proportion of health professionals who are effectively trained in the principles of asthma management and education and who undertake ongoing community education.
Variable patient access to asthma educators which needs to be increased.	An increase in the access to health professionals trained as asthma educators.
The number of asthma patients and carers trained in asthma management is unknown but probably sub-optimal.	An increase in the proportion of asthma patients and their carers with effective training in asthma management and in the optimum use of medication and devices.
Some discriminatory policies and practices still exist in areas such as employment.	A decrease in the proportion of people with asthma who are discriminated against because of their disease.
NAC will continue to address poor media coverage when it occurs¹⁵.	Improvement in the content and quality of information about asthma in the media.
Level of community awareness that asthma symptoms are largely preventable is unknown, but currently being addressed in public relations campaigns	An increase in awareness in people with asthma and their carers that the reduced quality of life imposed by asthma is largely preventable.
Asthma education support increasing but recognised lack of systematic planning and policies.	An increase in the level of support for asthma education in all sectors.
National Asthma Schools Policy approved and circulated in most states but implementation unknown	An increase in the number of schools and relevant organisations which have adopted the principals of the National Asthma Schools Policy
Teacher training levels are unknown but considered inconsistent.	An increase in the proportion of time devoted to asthma education in teacher training and professional development
Variable local programs to encourage doctor and pharmacist advice on medications.	An increase in the number of doctors and pharmacists who provide effective advice/ongoing care to patients when prescribing or dispensing; medication.
Preventer/reliever knowledge is still inconsistent¹⁶.	An increase in the understanding of the role of preventer versus reliever medications by people with asthma their doctors and carers.
Asthma education statistics currently known only for teaching hospital admissions. About 20% of those attending A & E at hospitals which have A & E programs receive asthma Education^17,11,13,10.	An increase in the proportion of people with asthma who have been admitted to hospital, or who have attended A & E, who are offered asthma education.
Unknown number of school staff willing to administer medication.	An increase in the proportion of school staff willing and able to administer asthma medication in appropriate circumstances.

Monitoring

Surveys of health and other relevant professionals to track changes in asthma-related attitude, knowledge and behaviour and to ascertain degree who manage in accordance with NAC guidelines
Data collection through ABS or other population surveys on medication and management plan use
Sales data on sale of devices
Population-based surveys to ascertain levels of asthma awareness within community
Analysis of undergraduate, postgraduate and professional education options to gauge the extent to which asthma management is handled in these courses, and the effectiveness of its teaching
Survey of/interviews with people with asthma to gauge attitude, knowledge and management practices
Tracking of numbers of asthma educators and funding for asthma education
Ascertaining numbers of schools and relevant organisations which have adopted the principles of the National Asthma Schools Policy.

Notes to Goal Three

1. Antic R, Bauman A, Mitchell C, et al. Ongoing impact of the mass media campaigns of the NAC in 1995. TSANZ, Perth 1996.

2. Henry R, Hazell J, Francis JL, Gibson PG, Toneguzzi R. Asthma education of nurses improves both knowledge and patient management. Aust N Z J Med 1994;24:952.

3. Charlton I, Antopiou, A, Atkinson, J, et al. Asthma at the interface: bridging gap between general practice and a district general hospital: Arch Dis 1994;70:313-18.

4. Comino E, Mitchell C, Bauman A, et al. Serial trends in childhood asthma management in Australia. Aust N Z J Med 1994; 24(4):462.

5. Comino E, Mitchell C, Bauman A, et al. Changes in adult asthma management in Australia. Aust N Z J Med 1994;24:(4):463.

6. McCardle N, Graham N, Allen C, Tavala R. Patients do not adhere to asthma management plans: information from a controlled study. TSANZ, Perth 1996.

7. Light L, Thien F, Lonigan A, Czarny D, Cohen H, Walters EA. A profile of asthma and its management in a public hospital asthma clinic compared with general practice. TSANZ, Perth 1996.

8. Comino EJ, Henry RL, Mitchell CA, et al. Mode of acquisition of inhaled bronchodilators: an epidemiological study. Aust N Z J Med 1995;25:496.

9. Rubinfeld AP, Dunt DR. Do patients understand asthma? A community survey of asthma knowledge. Med J Aust 1988;149:526-30.

10. McLeod SJ, Pearce MT, Rigby SA, et al. An audit of asthma management at a Christchurch hospital. Aust N Z J Med 1995;25:456.

11. Veitch E, Jenkins C. An audit of asthma care in casualty and the impact. An education program for resident medical officers. Aust N Z J Med 1994; 24:464.

12. Town I, Kwong T, Holst P, Beasley R. Use of a management plan for treating asthma in an emergency department. Thorax 1990;45:702-6.

13. Gibson PG, Talbot PI, Hancock J, Hawley MJ. A prospective audit of asthma management following emergency treatment at a teaching hospital. Med J Aust 1993;158:775-8.

14. Stewart K, Pappas A, Gowan J, Reed B, Roller L. Making CPE mandatory: What do Australian pharmacists think? Australian Pharmacist 1995;14(10): 606-8.

15. Sarma M, Alperts JH, Prideaux D, Kroemer D. The comprehensibility of Australian education literature for patients with asthma. Med J Aust 1995; 162:360-3.

16. Bauman, A, Mitchell C, Comino E, et al. A population survey of treatment compliance among adults with asthma, TSANZ, Perth 1996.

17. Allen DH, Allen RM, Jones MP. Referring adults to a special asthma clinic following hospital cure for acute asthma improves asthma management and health outcomes. Aust N Z J Med 1995: 26:453A.