Comprehensive approach needed for better asthma care

Simply developing evidence-based recommendations is not enough to improve asthma care. These recommendations should also be disseminated and implemented at national and local levels, then integrated into routine clinical practice to have a positive effect on patient outcomes, according to an expert.

Speaking at the ASPR 2023 Congress, Dr Fanny Ko from The Chinese University of Hong Kong, Hong Kong, underscored the need for a multifaceted approach for an effective asthma care that translates into better outcomes for patients.

When it comes to implementation, Ko acknowledged the value of learning from successful asthma care programs around the world.

In Finland, for example, a 10-year program that ushered in changes in asthma management—such as the primary care physician establishing asthma diagnosis instead of referring patients suspected of having asthma to a specialist and shifting from infrequent to frequent follow-up visits, among others—led to a 54-percent and a 69-percent drop in the number of hospital days and asthma admissions, respectively, from 1993 to 2003. This program, according to Ko, provides valuable insights that can inform strategies for implementation of asthma care recommendations.  [Thorax 2006;61:663-670]

Aside from ensuring that the implementation process is guided by robust evidence and proven practices, relevant professional groups and stakeholders should be engaged. Why it is essential for successful implementation of asthma care guidelines, Ko gave a variety of reasons.

One is to leverage the knowledge and experience of healthcare providers and other stakeholders regarding asthma care, ensuring that the guidelines are relevant and practical. Another is to overcome barriers and facilitate adoption. Healthcare professionals help pinpoint potential barriers to implementing asthma care guidelines, such as limited resources, cultural sensitivities, and logistic problems. Their involvement can also enable the adoption of guidelines by providing training, education, and support. [Int J Gen Med 2017;10:347-355; Korean Med Sci 2020;35:e72; BMJ Open 2022;12:e052058; BMC Fam Pract 2015;16:145]

Equally important is that specific cultural context and socioeconomic conditions of the target population be considered, Ko pointed out. This includes recognizing and addressing factors such as language barriers, access to healthcare resources, and cultural beliefs that may influence asthma management.

Ko also touched on the economic aspect of implementation programs. Their cost-effectiveness, she said, should be assessed to determine whether the programs are worth pursuing or, if not, ought to be modified, all with the goal of optimizing resource allocation, maximizing the impact of interventions, and ultimately improving patient outcomes.

Globally, asthma diagnosis and management guidelines should be updated, with relevant tools to support implementation efforts developed, according to Ko. Then, the assessment of local needs, adaptation of guideline recommendations to local context, development of implementation frameworks, and assessment of uptake and sustainability must all be done at a local level.

Ko outlined seven steps in implementing an asthma strategy into a health system. First, to develop a multidisciplinary working group. Second, to evaluate the current status of asthma care delivery, outcomes, care gaps, and current needs. Third, to select the material to be implemented and agree on main goals. Forth, to identify barriers to and facilitators of implementation. Fifth, to select an implementation framework and its component strategies. Sixth, to develop a step-by-step implementation plan. Seventh, to continually review progress and results to determine whether the strategy requires modification.

In Hong Kong, Ko shared that their local experience involves working with local patient groups such as the HK Asthma Society to provide education for patients, training of school teachers, and support for patients. Doctors and nurses, meanwhile, receive training from their institutions. Finally, talks, courses, and conferences are held to raise asthma awareness among stakeholders and the public.