Primary care based clinics for asthma.
TL;DR: There is limited evidence of efficacy for primary care based asthma clinics, and firm conclusions cannot be formed until more good quality trials have been carried out.
Abstract: Background
Asthma is defined as the presence of variable airflow obstruction with symptoms (more than one of wheeze, breathlessness, chest tightness, cough). It is becoming increasingly common worldwide and this is especially true in higher income countries. In several of these countries there has been a move towards delivery of asthma care via primary care based asthma clinics. Such clinics deliver proactive asthma care sited within primary care, via regular, dedicated sessions which are usually nurse led and doctor supported. They include organised recall of patients on an asthma register and care usually comprises education, symptom review and guideline-based management. Despite the proliferation of such clinics, especially in countries such as the United Kingdom (UK), there is a paucity of evidence to support their use. This review sets out to look at the evidence for the effectiveness of asthma clinics.
Objectives
To determine the effectiveness of organised asthma care delivered via primary care based asthma clinics.
Search methods
We searched the Cochrane Airways Group Specialised Register of trials (last search December 2011) and reviewed reference lists of all primary studies for additional references.
Selection criteria
We included randomised controlled trials of primary care based asthma clinics with a parallel group design, where clinics took place within dedicated time slots and included face-to-face interaction with doctor or nurse and control groups received usual clinical practice care by a general practitioner.
Data collection and analysis
Two review authors independently assessed the trials for inclusion and conducted all data extraction and analysis. All disagreements were resolved by discussion.
Main results
A total of three studies involving 466 participants were included. There was no statistically significant difference between the asthma clinic group and the control group for most outcomes (primary outcomes: asthma exacerbations leading to hospitalisation or accident and emergency (AE secondary outcomes: symptoms, time lost from work and withdrawals from the intervention or usual care). However, the confidence intervals were wide for all outcomes and there was substantial heterogeneity between the studies for both AE 95% CI 0.12 to 0.77). There were no studies looking at the secondary outcome of exacerbations requiring oral steroids.
Authors' conclusions
There is limited evidence of efficacy for primary care based asthma clinics, and firm conclusions cannot be formed until more good quality trials have been carried out.
Citations
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TL;DR: Evidence is reported on from systematic reviews and international studies that show that nurse practitioners improve healthcare outcomes, particularly for hard to service populations, and also maps out the limited Australian evidence on the impact of nurse practitioners' care in aged care settings.
Abstract: Aim. To consider evidence surrounding the emerging role of nurse practitioners in Australia with a particular focus on the provision of healthcare to older people. Methods. Methods used included keyword, electronic database and bibliographic searches of international literature, as well as review of prominent policy reports in relation to aged care and advanced nursing roles. Results. This paper reports on evidence from systematic reviews and international studies that show that nurse practitioners improve healthcare outcomes, particularly for hard to service populations. It also maps out the limited Australian evidence on the impact of nurse practitioners' care in aged care settings. Conclusions. If Australia is to meet the health needs of its ageing population, more evidence on the effectiveness, economic viability and sustainability of models of care, including those utilising nurse practitioners, is required.
26 citations
TL;DR: A comprehensive Australian and international literature review on nurse-led and nurse-involved primary healthcare interventions with a particular focus on those serving people with chronic and complex conditions and hard to reach populations is reported.
Abstract: Primary healthcare services in Australia need to respond to the needs of an ageing population and the rising prevalence of chronic and complex conditions in that population. This paper reports on the results of a comprehensive Australian and international literature review on nurse-led and nurse-involved primary healthcare interventions with a particular focus on those serving people with chronic and complex conditions and hard to reach populations. The key question this review addresses is: what role can nurses play in primary healthcare to manage people with chronic and complex conditions? International evidence demonstrates that nurses working in primary care provide effective care, have high patient satisfaction and patients are more likely to comply with nurse instructions than general practitioner instructions. Nurses can provide care equivalent to doctors within their scope of practice but have longer consultations. Lifestyle interventions provided by nurses have been shown to be effective for cardiac care, diabetes care, smoking cessation and obesity. The nursing workforce can provide appropriate, cost-effective and high-quality primary healthcare within their scope of practice.
25 citations
TL;DR: There has been no systematic assessment of the impact of haemophilia care delivery models on patient‐important outcomes, and this work is the first to systematically assess these models through a multi-disciplinary approach.
Abstract: Background
Haemophilia care is commonly provided via multidisciplinary specialized management. To date, there has been no systematic assessment of the impact of haemophilia care delivery models on patient-important outcomes.
Objective
To conduct a systematic review of published studies assessing the effects of the integrated care model for persons with haemophilia (PWH).
Search methods
We searched MEDLINE, EMBASE and CINAHL up to April 22, 2015, contacted experts in the field, and reviewed reference lists.
Selection criteria
Randomized and non-randomized studies of PWH or carriers, focusing mainly on the assessment of care models on delivery.
Data collection and analysis
Two investigators independently screened title, abstract, and full text of retrieved articles for inclusion. Risk of bias and overall quality of evidence was assessed using Cochrane's ACROBAT-NRSI tool and GRADE respectively. Relative risks, mean differences, proportions, and means and their variability were calculated as appropriate.
Results
27 non-randomized studies were included: eight comparative and 19 non-comparative studies. We found low- to very low-quality evidence that in comparison to other models of care, integrated care may reduce mortality, hospitalizations and emergency room visits, may lead to fewer missed days of school and work, and may increase knowledge seeking.
Conclusion
Our comprehensive review found low- to very low-quality evidence from a limited number of non-randomized studies assessing the impact of haemophilia care models on some patient-important outcomes. While the available evidence suggests that adoption of the integrated care model may provide benefit to PWH, further high-quality research in the field is needed.
24 citations
TL;DR: Integrated care models have been adopted for individuals with chronic conditions and for persons with rare diseases, such as haemophilia.
Abstract: Background
Integrated care models have been adopted for individuals with chronic conditions and for persons with rare diseases, such as haemophilia.
Objective
To summarize the evidence from reviews for the effects of integrated multidisciplinary care for chronic conditions in adults and to provide an example of using this evidence to make recommendations for haemophilia care.
Search methods
We searched MEDLINE, EMBASE, CINAHL and Cochrane Database of Systematic Reviews up to January 2016, and reviewed reference lists of retrieved papers.
Selection criteria
Systematic reviews of at least one randomized study, on adults with non-communicable chronic conditions.
Data collection and analysis
Two investigators independently assessed eligibility and extracted data. Quality of reviews was assessed using ROBIS, and the evidence assessed using GRADE.
Results
We included seven reviews reporting on three chronic conditions. We found low to high quality evidence. Integrated care results in a reduction in mortality; likely a reduction in emergency visits and an improvement in function; little to no difference in quality of life, but shorter hospital stays; and may result in little to no difference in missed days of school or work. No studies reported educational attainment, or patient adherence and knowledge. When used for haemophilia, judgment about the indirectness of the evidence was driven by disease, intervention or outcome characteristics.
Conclusion
This overview provides the most up to date evidence on integrated multidisciplinary care for chronic conditions in adults, and an example of how it can be used for guidelines in rare diseases.
21 citations
TL;DR: Simultaneously combining several action plans, each focusing on different aspects of asthma management, seems most likely to be effective.
Abstract: Background: Despite growing access to effective therapies, asthma control still needs improvement. Many non-drug factors, such as allergens, air pollutants and stress also affect asthma control and...
16 citations
Cites background from "Primary care based clinics for asth..."
...Nurse-led asthma clinics in primary care settings seem to offer few advantages over standard care [79]....
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References
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Journal Article•
12,135 citations
Journal Article•
TL;DR: The variation in the prevalences of asthma, allergic rhinoconjunctivitis, and atopic-eczema symptoms is striking between different centres throughout the world and will form the basis of further studies to investigate factors that potentially lead to these international patterns.
3,584 citations
TL;DR: This report provides a wealth of information that will be an invaluable source of information for those who wish to explore available data on the burden of asthma by region and will be extremely useful to develop background materials for World Asthma Day activities in 2004 and well into the future.
Abstract: It is estimated that as many as 300 million people of all ages, and all ethnic backgrounds, suffer from asthma and the burden of this disease to governments, health care systems, families, and patients is increasing worldwide. In 1989 the Global Initiative for Asthma (GINA) program was initiated in an effort to raise awareness among public health and government officials, health care workers, and the general public that asthma was on the increase. The GINA program recommends a management program based on the best available scientific evidence to provide effective medical care for asthma tailored to local health care systems and resources. Working in continued collaboration with leaders in asthma care from many countries, GINA sponsors World Asthma Day (first Tuesday in May) which has been extremely successful. A vast number of people have made a commitment to bring awareness about the burden of asthma to their local health care officials, and to implement programs of effective asthma care. Beginning in 2003, the theme of World Asthma Day has been the ‘‘Global Burden of Asthma.’’ GINA commissioned Professor Richard Beasley, Wellington, New Zealand (member, GINA Dissemination Committee) to provide available data on the burden of asthma. A summary of this report is provided in this publication; the full document with data sets for 20 different regions worldwide may be obtained from the GINA website (http://www.ginasthma.com). Professor Beasley and his colleagues obtained data on the burden of asthma from literature primarily published through the International StudyofAsthmaandAllergies in Childhood (ISAAC) and the European Community Respiratory Health Survey (ECHRS). Methodologies differ in these studies, and epidemiological data on asthma are very difficult to collect, as Professor Beasley carefully describes in his segment on ‘‘Methodological Issues.’’ Nonetheless, the full report provides a wealth of information, along with a large number of scientific references. The study regions have been grouped according to geographical, political, historical, and racial considerations based on official data from WHO, the United Nations (UN), and other sources, and to some extent, the availability of asthma epidemiological data within the study region. Using the United Nations World Population Prospect Population Database (http://esa.un.org/unpp) as a source within each region, all countries were included, and in some cases territories and dependencies if specific asthma epidemiological data were available. For simplicity some data from small territories have been omitted or lumped in a larger sub-regional unit. The report will be updated as new information becomes available and following feedback from individual countries and regions. The GINA Executive Committee is indebted to Professor Beasley and his colleagues for providing this report that will be an invaluable source of information for those who wish to explore available data on the burden of asthma by region. It will be extremely useful to develop background materials for World Asthma Day activities in 2004 and well into the future. Matthew Masoli, Denise Fabian, Shaun Holt, Richard Beasley for the Global Initiative for Asthma (GINA) Program
3,418 citations
TL;DR: In this article, the authors investigated worldwide prevalence of asthma, allergic rhinoconjunctivitis, and atopic disorders in children, and found differences of between 20-fold and 60-fold between centres in the prevalence of symptoms of asthma.
3,019 citations
TL;DR: It is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained, and the Global Initiative for Asthma recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions.
Abstract: Asthma is a serious health problem throughout the world During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively However, recommendations for asthma care need to be adapted to local conditions, resources and services Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations A comprehensive workshop report entitled "A Global Strategy for Asthma Management and Prevention", first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines The 2006 report contains important new themes First, it asserts that "it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained," and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised
2,880 citations