pace australia intervention
DESCRIPTION
American Thoracic Society (ATS) Annual Meeting 2011Dr Smita ShahDirector, Primary Health Care Education and Research UnitPrimary Care and Community Health NetworkClinical Senior Lecturer, School of Public HealthWestern Clinical School, Poche Centre for Indigenous HealthThe University of Sydney, AustraliaTRANSCRIPT
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Dr Smita ShahDirector, Primary Health Care Education and Research Unit
Primary Care and Community Health NetworkClinical Senior Lecturer, School of Public Health
Western Clinical School, Poche Centre for Indigenous HealthThe University of Sydney, Australia
Susan Sawyer, Brett Toelle, Craig Mellis, Jenny Peat, Marivic Lagleva, Tim Usherwood, Christine Jenkins
PACE Australia Intervention
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Australia
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Population: 3.2 million
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Overview
PACE Australia program
How the program differs from the original
Australian RCT study results
Dissemination
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PACE Australia partners
Western Clinical School, University of Sydney
Woolcock Institute of Medical Research, Sydney
Centre for Adolescent Medicine, Royal Children’s Hospital, Melbourne
University of Michigan, USA
Funded by the Australian Government Department of Health & Ageing
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Phase 1: 2003-04
Collaboration with N Clark and M.Cabana
Steering committee established
Program modified to the Australian context and current evidence
Practitioner Asthma Communication & Education (PACE) Australia
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Program comparison
Similarities
Program framework
10 Communication strategies
10 Education messages
Video
Small group format
Expert presenters
Differences
Patterns of asthma
Asthma medications
Writing action plans
Australian remuneration
Teaching asthma devices
More interactive
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PACE Australia Session 1
Clinical aspects
Patterns of asthma
Case studies
Asthma medications
Asthma Action Plans
Communication strategies
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PACE Australia Session 2
Q&A
Self-Rating Scale
Patient education DVD
Case studies
Asthma Cycle of Care
Asthma devices
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PACE Australia Doctor’s Kit
Copy of slides Asthma Action Plans Communication & education
strategies NAC Asthma Management
Handbook ‘Airways’ Samples of asthma devices
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25 GPs Evaluation
To measure change in doctors communication behaviour
To obtain feedback about the program and identify its acceptability for more robust testing of the program with Australian GPs
Phase 1: Feasibility study
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ResultsProgram content and interactivity rated very highlyMost useful components
communication skills
patterns of asthma
devices Suggestions
increase time by 30 mins
re-make video using Australian actors›
› Shah S et al., Australian Journal of Primary Health Care 2010
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12 months pre workshop
1 month post workshop
Difference P value
Mean “How Confident” score(1= not at all confident to 6 = extremely confident)
4.2 5.03 0.8 < 0.0001
Mean “How Helpful” score(1= not at all helpful to 6 = extremely helpful)
5.0 5.5 0.5 0.01
Mean “How Often” score (1= never to 6 = often)
4.6 5.2 0.6 0.0001
GPs - communication behaviours
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Phase 2: 2005
Development of program resources
PACE Australia Presenter’s manual
Train the Trainer program and Manual
Australian video: Talking Asthma
RCT funding proposal
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Aim To measure the impact of PACE on processes, costs and
outcomes of GPs management of children with asthmaMethods
RCT in primary health careRecruitment
General Practitioners in Sydney Children with doctor diagnosed asthma
Questionnaires (adapted from PACE, USA)GPs- self reported questionnaire
Patients – parent interviews; independent monitor
Phase 3: 2006 – 2010
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PACE Australia Outcomes
Primary outcome
Possession of a written asthma action plan
Secondary outcomes
Medication appropriate to pattern of asthma
Parent/ child days away from work and school
Use of Asthma Cycle of Care by GPs
Education of asthma device use
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Results
PACE USA PACE Australia
Target Primary Care Paediatricians General Practitioners
Asthma severity
Moderate-Severe Mild-Moderate
ICS use Suboptimal Inappropriate
Variation in baseline study population
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Use of ICS by asthma classification
Percent difference between intervention and control group & 95% CI
-40 -20 0 20 40 60 80
Infrequent intermittentsymptoms
Frequent intermittent symptoms
Persistent symptoms
Favours intervention
Favours intervention
P=0.03
P=0.82
P=0.71
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Outcomes: NNT
General Practitioners NNT
Completion of asthma cycle of care 3.3
Prescribing a spacer device 3.5
Providing written action plan>70% of time 4.3
Patients
Child with persistent symptoms using ICS 4.0
Child with infrequent symptoms not using ICS 4.2
Written action plan in last 12 months 5.4
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Key differences in results
Target population
Asthma severity
Different outcomes
Written Asthma Action Plans
Patterns of Asthma
Asthma medications and devices
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Dissemination
Publication of RCT
PACE Australia Kit Train the trainer manual
Talking Asthma DVD
Further research Pharmacists/nurses
Adults with asthma
Use the methodology for other chronic diseases
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RE-AIM / PACE Australia
Reach High - Individual level
Efficacy High – Individual level
Adoption ? - organisation
Implementation Medium - organisation
Maintenance High – individual
Organisation –low
How does PACE Australia fit the RE-AIM framework?
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Questions
How best to take PACE Australia further?What is GINA's role for dissemination of evidence-based programs?
Is there a role for organisations such as ATS/TSANZ play in advocating for funding of evidence-based programs?
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