Download NHLBI’s Efforts in Addressing COPD

Collaborating to Put
Evidence-based Asthma
Care Into Action
James P. Kiley, M.S., Ph.D.
Director
Division of Lung Diseases
National Capital Region Asthma Partnership
Conference
May 6, 2010
Burden of Asthma
• Lost productivity
 11 million work days lost per year
 14 million school days lost per year (21% children w. asthma miss
>2 weeks)
 50% of national survey sample missed >6 days in one year
• Reduced quality of life
 >10% of people with asthma restrict activities
 48% parents in national survey have children avoid exertion
 30% don’t sleep through the night
• High morbidity
 484,000 hospitalizations, all ages
 Most common reason for hospitalization in children
• High cost
 $20.7 billion annual direct & indirect costs (projected 2010)
• Death
 3,365 deaths in 2006
NAEPP EPR-3
Guidelines Implementation Panel (GIP) 2008
Prioritized 6 key messages from
evidence based EPR-3
• Inhaled steroids are most effective
for long term control
All patients should receive:
• Written Action Plan
• Initial assessment of severity
• Follow up assessment of control
• Regular “asthma check ups”
• Assessment and advice about
environmental exposures
Discrepancy Between Promise of
Control and Reality
From numerous studies:
•
Physicians prescribe inhaled corticosteroids inappropriately: e.g., one study
showed only 30% of patients with persistent asthma were on inhaled
corticosteroids.
From recent nationwide survey of adults with asthma*:
•
Patients do not use medications appropriately:
 42% reported they intermittently stop taking ICS
•
Patients do not appreciate that Asthma Can Be Controlled
 70% said their asthma was “in control” BUT 47% of them actually had poorly
controlled asthma.
 16% reported use of quick-relief inhaler every day
 29% reported fear of asthma attacks keep them from doing the things they want
*Asthma Insight and Management Survey; Medical News Today, Nov. 2009 (national sample; sponsored
by Schering and Merck)
What Can Make the Promise Real?
• Understanding and believing that
ASTHMA CAN BE CONTROLLED
• Adherence, Adherence, Adherence
Factors Influencing Patient
Adherence
Patient-provider
communication is a
partnership
Adherence
Phenotype
External Supports are
in place
- Social/family
- Access to care
- Reinforcement
Treatment Regimen:
- Fits into daily routine
- Can discuss &
overcome fears/barriers
Patient Characteristics
- Expects treatment to work
- Has self-management skills
- Has belief in self-efficacy
Factors Influencing Physician
Adherence
Expects guidelines
will work
Has skills & self efficacy
Adherence
Phenotype
Can overcome inertia
of previous practice
routines
Is familiar with
guidelines
External Supports are in Place
- Time
- Reimbursement
- Space & Equipment
- Patient education materials
Factors to Promote Adherence
• Involve different groups and improve
communication among them:
 Patients and public
 Healthcare providers
 Schools and community
groups
■
■
Policy makers
Health Systems
• Foster systems integration
• Create tools for patients and providers
National Asthma Control
Initiative (NACI)
• NACI, launched by NAEPP, puts the
EPR-3 priority messages and strategies
in motion nationwide through partnership
activities
NACI Commitments to National
Capitol Region
• Children’s Research Institute at Children’s National Medical Center
in DC: will pilot electronic Asthma Encounter Form to transition
patients from ED to Primary Care
• Allergy and Asthma Network: will pilot self-paced asthma
education for patients and families
• Medical Society of Virginia Foundation: will create a maintenance
of certification asthma education module for physicians
• National Respiratory Training Center: will conduct continuing
medical education program for physicians and allied health
professionals
• National Environmental Education Foundation in DC: will train
medical school faculty, students, and residents to use
key messages with focus on environmental management
NACI
• Keep in touch with NACI: to start, sign up
for In the Know e-Newsletter.
• NACI congratulates National Capital
Region Asthma Partnership initiatives.
• Your collaborative projects will improve
patient and provider adherence to
strategies that will realize the promise of
Asthma Control.
Research, Guidelines & Clinical Practice
A Dynamic Interaction
Clinical Practice Communities
Guidelines
• Implement Guidelines in clinic and
community settings
• Provide recommendations
for clinical practice
• Share lessons learned
• Identify gaps in evidence
• Observe variations in responsiveness
• Identify clinical controversies
• Help define research questions & priorities
NACI support
Clinical Research
•
Investigate issues of clinical
concern
•
Study results provide evidence
for updating guidelines
Judith Taylor-Fishwick, MSc, AE-C
Director (USA Office)
National Respiratory Training Center
Suffolk, Virginia