Implementing Practice Guidelines: A Workshop on Guidelines Dissemination and Implementation with a Focus on Asthma and COPD

Abstract

The present supplement summarizes the proceedings of the symposium "Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD", which took place in Quebec City, Quebec, from April 14 to 16, 2005. This international symposium was a joint initiative of the Laval University Office of Continuing Medical Education (Bureau de la Formation Médicale Continue), the Canadian Thoracic Society and the Canadian Network for Asthma Care, and was supported by many other organizations and by industrial partners. The objectives of this meeting were to examine the optimal implementation of practice guidelines, review current initiatives for the implementation of asthma and chronic obstructive pulmonary disease (COPD) guidelines in Canada and in the rest of the world, and develop an optimal strategy for future guideline implementation. An impressive group of scientists, physicians and other health care providers, as well as policy makers and representatives of patients' associations, the pharmaceutical industry, research and health networks, and communications specialists, conveyed their perspectives on how to achieve these goals. This important event provided a unique opportunity for all participants to discuss key issues in improving the care of patients with asthma and COPD. These two diseases are responsible for an enormous human and socioeconomic burden around the world. Many reports have indicated that current evidence-based guidelines are underused by physicians and others, and that there are many barriers to an effective translation of recommendations into day-to-day care. There is therefore a need to develop more effective ways to communicate key information to both caregivers and patients, and to promote appropriate health behaviours. This symposium contributed to the initiation of what could become the "Canadian Asthma and COPD Campaign", aimed at improving care and, hence, the quality of life of those suffering from these diseases. It is hoped that this event will be followed by other meetings that focus on how to improve the transfer of key recommendations from evidence-based guidelines into current care, and how to stimulate research to accomplish this.

Can Access to Spirometry in Asthma Education Centres Influence the Referral Rate by Primary Physicians for Education?

“…Indeed, of the more than 300 physicians in current practice to whom the advertisement describing the AEC's activities was sent, only a small number referred patients, regardless of the services offered. This is in keeping with recent surveys showing persistent care gaps in asthma management (8)(9)(10)16).…”

“…Among various care gaps observed in asthma management, underutilization of objective measurement of airway obstruction has been reported, as well as inadequate assessment of overall disease severity or control (7)(8)(9). The insufficient use of spirometry may be due to the lack of availability of or delayed access in obtaining it, as well as a lack of integration of these assessments in current practice.…”

“…The other significant care gap in asthma management, which is the lack of referral to an asthma educator for adequate education about self-management of asthma, has been regularly observed (8,9). However, this was considered to be one of the main ways to reduce asthma-related morbidity and acute health care use (1,(11)(12)(13)(14)(15).…”

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

“…[535][536][537][538] Some of the barriers to implementation of evidence-based asthma management relate to the delivery of care, while others relate to patients' attitudes (see , and examples in Appendix Chapter 7, Box 7-1). Cultural and economic barriers can particularly affect the application of recommendations.…”

Management of acute asthma in adults in the emergency department: assisted ventilation

“…Many of these gaps may be lessened by efforts to improve the dissemination and implementation of asthma guidelines. 66 There is a need for better research into the possible role of noninvasive ventilation in routine treatment for acute asthma, as well as research into novel ways of applying mechanical ventilation, including self-adjustment based on real-time physiologic and neuronal feedback. Although permissive hypercapnia is well tolerated, more research into the safety of this ventilation strategy is required.…”