Collaborating to Put Evidence-based Asthma Care Into Action

1. 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

2. 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

3. 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

4. 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)

5. What Can Make the Promise Real? • Understanding and believing that ASTHMA CAN BE CONTROLLED • Adherence, Adherence, Adherence

6. Factors Influencing Patient Adherence Patient-providercommunication 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

7. 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

8. Factors to Promote Adherence • Involve different groups and improve communication among them: • Patients and public ■ Policy makers • Healthcare providers ■ Health Systems • Schools and community groups • Foster systems integration • Create tools for patients and providers

9. National Asthma Control Initiative (NACI) • NACI, launched by NAEPP, puts the EPR-3 priority messages and strategies in motion nationwide through partnership activities

10. 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

11. 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.

12. Research, Guidelines & Clinical PracticeA Dynamic Interaction • Clinical Practice Communities • Implement Guidelines in clinic and community settings • Share lessons learned • Identify clinical controversies • Observe variations in responsiveness • Help define research questions & priorities • NACI support • Guidelines • Provide recommendations for clinical practice • Identify gaps in evidence • Clinical Research • Investigate issues of clinical concern • Study results provide evidence for updating guidelines

13. Judith Taylor-Fishwick, MSc, AE-C Director (USA Office)National Respiratory Training Center Suffolk, Virginia