James P. Kiley, M.S., Ph.D.Director

Division of Lung Diseases

National Capital Region Asthma Partnership ConferenceMay 6, 2010

Collaborating to Put Evidence-based

Asthma Care Into Action

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

NAEPP EPR-3 Guidelines Implementation Panel (GIP)

2008Prioritized 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

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)

What Can Make the Promise Real?

• Understanding and believing that ASTHMA CAN BE CONTROLLED

• Adherence, Adherence, Adherence

Factors Influencing Patient Adherence

Adherence Phenotype

Patient-providercommunication is a

partnership

External Supports are in place - Social/family - Access to care - Reinforcement

Patient Characteristics- Expects treatment to work- Has self-management skills- Has belief in self-efficacy

Treatment Regimen:- Fits into daily routine - Can discuss & overcome fears/barriers

Factors Influencing Physician Adherence

Adherence Phenotype

Expects guidelines will

work

Has skills & self efficacy

Can overcome inertia of previous practice routines

Is familiar with guidelines

External Supports are in Place - Time - Reimbursement - Space & Equipment - Patient education materials

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

National Asthma Control

Initiative (NACI)

• NACI, launched by NAEPP, puts the EPR-3 priority messages and strategies in motion nationwide through partnership activities

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

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.

Research, Guidelines & Clinical Practice

A Dynamic Interaction

Guidelines•Provide recommendations for clinical practice

•Identify gaps in evidence

Clinical Research• Investigate issues of clinical

concern

• Study results provide evidence for updating guidelines

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

Judith Taylor-Fishwick, MSc, AE-C

Director (USA Office)National Respiratory Training Center

Suffolk, Virginia