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Background In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy. Main body As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted “patient activation”, (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Santé as a Good Practice in the field of digitally-enabled, integrated, person-centred care. Conclusion In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.

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Background: In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently. Methods: All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users selfassessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated. Results: A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures. Conclusions: VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.

Objectives: To explore the opinions and experiences of a range of stakeholders on inter-professional working relationships between community pharmacists and physicians. Study design: Five qualitative studies. Setting: Primary care. Population and Methods: Thirty-one community pharmacists, eight medical and pharmacy leaders, 12 physicians and 21 patients took part in interviews and focus groups reflecting on medicines management services in Portuguese community pharmacy. Data pertaining to inter-professional work was subjected to thematic content analysis with the aid of NVIVO® software. Results: Generally, datasets offer evidence of immature inter-professional working relationships. Data analysis suggests a mismatch between the role pharmacists perceived for themselves and physicians' perceptions. A second key theme in explaining barriers to inter-professional work is its perceived benefits. Once again, a mismatch was found between physicians, who generally perceived little benefit for patients or for themselves, and pharmacists, who were keen to collaborate and anticipated benefits for patients. A third key theme was that of role encroachment. Analysis suggests that territorial behaviour was evident in both professions. More clinical roles were perceived as an invasion of physicians' professional practice both by physicians and community pharmacists, but the latter showed unwillingness to compromise on these newly extended roles. Facilitators mentioned by participants included increasing awareness of the pharmacist's role and services, adopting aspects such as joint training, and informal and formal inter-professional meetings. The use of protocols for collaboration and clinical data sharing were also identified as facilitators for inter-professional work. Conclusions: Inter-professional work between community pharmacists and physicians appears to be in an early stage of development. Multi-modal strategies combining top-down and bottom-up approaches seem necessary to advance inter-professional work to a collaboration level that can contribute to patient safety in the medication use process.