Dear IPCRG Colleague,
Welcome to this "Bumper Christmas edition" of our newsletter! Find out what has been happening at IPCRG over the past few months and our plans for 2020.
Please note we will be closed from Friday 20th December at 17.00 GMT, reopening on Monday 6th January 2020 at 09.00 GMT.
We wish everyone the very best from all of us at IPCRG for the New Year.
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Welcome our new Education sub-committee chair
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We are delighted to announce that Prof Amanda Barnard, Interim Head, School of Medicine JPM, Charles Sturt University, Australia has been appointed chair of the IPCRG Education Sub Committee. We thank Prof Hilary Pinnock for all her support and advice during her time in this role; IPCRG's track record in delivering high quality education programmes for primary care is now substantially richer.
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IPCRG has been re-elected as the primary care representative on the WHO Global Alliance against Chronic Respiratory Diseases (WHO-GARD) and promotes the role primary care can play in the detection, diagnosis and treatment of asthma and COPD and in public education. In particular, we have been emphasising the need for investment in skills to diagnose and communicate the diagnosis of asthma and COPD effectively because there is significant in-country and between-country variation in diagnosis rate and accuracy.
PowerPoint Presentations and ePosters presented at the 13th GARD General Meeting, including those from IPCRG, and a new Beijing Call to Action are now available for viewing via the GARD website (https://gard-breathefreely.org) in the resources page.
To view ePosters: https://gard-breathefreely.org/resources-poster2019/
To view PowerPoint slides: https://gard-breathefreely.org/ppt2019/
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Active Patients’ ACCESS Care Report on Asthma and COPD Care, Diagnosis, Prevention and Empowerment
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Our associate member, European Federation of Allergy and Airways Diseases Patients’ Associations, published in October 2019 Active Patients’ ACCESS Care Report on Asthma and COPD Care, Diagnosis, Prevention and Empowerment. This is a report based on phone interviews with 774 adults with asthma and COPD recruited mainly via their GPs from Finland, France, Germany, Italy, Poland, Spain and the UK between November 2018 and January 2019.
Diagnosis
There is a strong focus on the wide range of experience of diagnosis: missed diagnosis, misdiagnosis and late diagnosis for asthma and COPD. They conclude:
"Unfortunately, we cannot as yet determine if the wrong diagnosis rate among pulmonologists and general practitioners is due to the quantity of cases they treat, to their interpretation of diagnostic results or due to other issues concerning the patient, such as the timing and accuracy in reporting their symptoms. In any case, having one in six people with asthma misdiagnosed is a burden that the patient community cannot accept."
Tobacco and air pollution
Given our strong interest in tobacco, there were some interesting findings:
"In the words of the European Medicines Agency (EMA), smoking cessation is the sole treatment that appears to best modify the rate of decline in lung function and to improve overall survival. https://www.ema.europa.eu/en/clinical-investigation-medicinal-products-treatment-chronic-obstructive-pulmonary-disease-copd.
However, it is striking that only 53% of patients in all countries surveyed utilise smoking cessation treatment."
"Up to nine in ten patients consider smoking as the factor that impacts the most their asthma and COPD. Alarmingly, 51% of asthma patients and 76% COPD patients stated that their parents smoked."
"Tobacco smoke is patients’ biggest concern. Nine in ten patients consider tobacco smoke as the indoor pollutant that triggers the most asthma and COPD symptoms. They believe that authorities did a good job in protecting citizens against tobacco smoke in indoor spaces through the the promotion of smoke-free environments."
"Concretely, patients are aware of the risk factors and call for more indoor and outdoor environmental protection, less air pollution in cities and the reduction of the level of particulate matter (PM210) resulting from traffic."
Prevention knowledge
"An overwhelming majority (92%) of patients report that avoiding active and passive smoking is the top prevention measure that could most improve the situation of asthma and COPD patients. They also identify good mental health and promoting and enabling a healthy lifestyle as contributors to a better situation for patients. This includes physical activity, eating healthy and avoiding stress. Other factors intimately linked to disease management, such as frequent check-ups, disease education or access to real life information on air quality can also enable a better health condition."
Inhaler training
"The good news is that training on how to inhale is provided to the vast majority of the asthma and COPD patients - only 6% of patients report never having received this training. The bad news is that one out of three patients received training or advice on how to inhale only once, and this was probably right after the diagnosis."
To read more: http://www.efanet.org/campaigns/showleadership which has full report and factsheets summarising findings per country.
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Research School in Bangladesh
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Thanks to Esther Metting and Jim Reid for giving keynote talks at Pulmocon, the biennial meeting run by the Bangladesh Lung Foundation and for facilitating an introduction to research for primary care physicians with our partners BPCRS. Congratulations to the successful delegates!
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A new external website for IPCRG
We are continuing to develop a new external website with a more user-friendly interface and good navigation capabilities, enabling our audiences to identify and access IPCRG tools, research and other materials more easily and quickly. We expect the new website to go live in Q1 2020 and will update you as soon as it is available. Below is a preview of our new resources search page.
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10th IPCRG World Conference, Breathing & Living Well: The Importance of Primary Care, Croke Park, Dublin 28-30 May 2020
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Conference Session Submission:
Thank you to all of you who submitted a session proposal for the 2020 IPCRG World Conference. We were delighted to receive over 50 submissions and our Scientific Programme Committee now has the challenging task of reviewing all submissions and creating an ambitious and comprehensive programme, relevant for primary care. We will be announcing the programme at the end of January 2020 and those who submitted proposals will know the outcome on January 27th 2020.
Abstract Submission for Oral Presentation and Poster Display:
Now that the deadline for session submissions has passed, there is still plenty of time to submit an abstract for either an oral presentation or poster display and the deadline for this is 2359hrs GMT on January 27th, 2020.
Abstracts can be submitted here and the Call for Abstracts can be viewed on the conference website, www.ipcrg2020.org.
There are three different categories for abstracts that can be submitted for the 10th World Conference and they are as follows:
Clinical Research Results Abstract
IPCRG campaigns for patient care to be evidence-based but using evidence from real life using representative populations. This category is for applied clinical research or implementation science that contains qualitative and/or quantitative data related to a study involving patients with respiratory disease or problems commonly found in primary and community care settings.
Implementation Science/Service Development Abstract
This category is an opportunity for you to share your learning about improving a service or implementing the evidence in a new setting. For example, you may have tackled variation in emergency hospital admissions for children with asthma in your area. These abstracts must also include data.
Research Ideas Abstract on Respiratory Conditions and Tobacco Dependency
We are aware that there are few academic centres of primary respiratory care and access to academic expertise to guide and mentor their research is not easy to find. Therefore IPCRG accepts abstracts that describe a research question and a methodology that would benefit from peer discussion and challenge.
Short ‘TAPAS’ Presentations
In addition to the above, at the 9th IPCRG World Conference in Porto we introduced another option for delegates to share their work outside of the usual Oral Presentation/Poster Display option. This was a session of 12 short oral presentations of 5 mins’ each. Both delegates and presenters enjoyed this session and are repeating it in 2020. We are looking for ideas in this session rather than evidence-based research. The idea could be based on a single practice or on a larger scale and cover, for instance the best use of appointment times or medicines optimisation using a Practice Pharmacist.
Remember the deadline for submitting an abstract is 27 January 2020 at 2359hrs GMT.
Why come to Dublin?
Dublin, Ireland is frequently cited as one of the Top 10 cities in the world to visit. Dublin is a dynamic city, steeped in heritage and surrounded by the mountains and the sea. Time and time again visitors comment on its friendliness. Dublin is guaranteed to surprise and delight you. For a flavour of Dublin and Ireland in general, please click here.
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1st IPCRG China Conference Beijing, 23-25 October 2020
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The 1st IPCRG China Conference, a cooperation between IPCRG & CARD-PC will be held in Beijing, October 23rd-25th 2020. The conference aims to bring together physicians, primary care physicians, researchers, medical officers and other personnel interested in respiratory medicine to discuss with each other new technology and new developments. The programme includes both clinical and scientific issues in primary care about diagnosis and management of asthma and COPD. It will cover pharmacological and non-pharmacological approaches such as shared decision-making, pulmonary rehabilitation and smoking cessation and task-shifting and sharing.
IPCRG is coordinating the faculty for a Teach the Teacher programme and Research School, as well as keynote lectures. CARD-PC is keen to welcome colleagues from neighbouring countries.
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IPCRG partnership with Medscape Education Global
We are at the final stages of review of the CME materials generated through our partnership with Medscape Education Global on the diagnosis and management of people with difficult to manage asthma, exploring when to refer, what to expect from a referral to a hospital specialist, and giving an update on treatments for severe asthma. In addition to two roundtable discussions, there will be commentaries in French, Spanish, Italian and German; an interactive simulated case with a patient, and further resources. It has been a great IPCRG team effort to produce and review these, so watch this space for the formal launch and get your CME credits!
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Sri Lanka signs MOU with Public Health Foundation India
The IPCRG-endorsed Certificate course in Management of COPD & Asthma has been adopted by Primary Care Respiratory Group (PCRG) Sri Lanka. Sri Lanka is the first IPCRG member country to have adopted this course for primary care physicians. The formal MOU was signed between PHFI and PCRG, Sri Lanka on the 1st December in Colombo. PHFI will be attending our 10th World Conference in Dublin, and look forward to meeting other country representatives to spread the programme further.
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Two new desktop helpers on their way!
We are at the final stages of two new desktop helpers: the 3rd edition of Appropriate use and withdrawal of inhaled corticosteroids in patients with COPD and a new one on the rational use of inhaled medications for people with COPD and multi-morbidities. They'll be available early next year.
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Teach the Teacher: Improving Diagnosis and Management of Children with Asthma.
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Asthma remains a common chronic condition in children worldwide, often with variable or poor diagnosis and management. Earlier this year, we reported on an international meeting in Kuala Lumpur to launch a Teach the Teacher programme on improving diagnosis and management of children with asthma. At the tier 1 international meeting in April, IPCRG international faculty and educational leaders from Malaysia, Singapore, Spain and the US worked together to co-create a master curriculum on how to teach as well as key clinical content on diagnosis and management of paediatric asthma.
In November, the Malaysian Faculty ran a successful tier 2 programme for 19 primary care educators in Malaysia. In a three day programme, participants were introduced to core concepts and teaching practices and adapted the core curriculum to the Malaysian primary healthcare setting. The programme included a participant evaluation and peer feedback on teaching practice. The programme has resulted in a cohort of primary care educators, who are part of a wider international network, with specialised knowledge and the potential to extend education programmes to frontline health care workers.
See here for more information on the Teach the Teacher Programme including short videos on why we believe Teach the Teacher programmes make a difference.
The project is funded by an independent education grant from GSK.
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In September our colleague Dr Cristina Isar represented IPCRG at an important global health conference in London, sharing the Romanian experience of our Global Bridges project.
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This research was funded by the National Institute for Health Research (NIHR), NIHR Global Health Research Group on Global COPD in Primary Care, University of Birmingham (Grant reference number 16/137/95), using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.
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Working with partners in Kyrgyzstan, India, Sri Lanka and Uganda, the NIHR Global RECHARGE project seeks to restore the health of people living with chronic respiratory diseases through the development of effective pulmonary rehabilitation programmes.
The first phase of the project has been exploring the initial knowledge, attitudes and perspectives of patients and healthcare professionals through surveys. The second phase has been determining how a western pulmonary rehabilitation service should be adapted to local cultures and specific respiratory conditions, such as post-tuberculosis lung disease, through interviews with prospective referrers and focus groups with patients.
The final research phase will be to conduct feasibility or fully-powered randomised controlled trials comparing locally-adapted pulmonary rehabilitation with usual care. Throughout these activities, partners will enhance their research capacity through training and hands-on experience. As part of the development of pulmonary rehabilitation in low- and middle-income countries, Global RECHARGE has created a standard set of measures to allow international benchmarking for current and future partners.
With the support of the IPCRG and British Thoracic Society, the project is helping partners to set up and deliver high quality pulmonary rehabilitation services locally, nationally and throughout the regions. Ultimately, Global RECHARGE aims to leave a legacy of research capacity and high quality pulmonary rehabilitation services in low- and middle-income countries.
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IPCRG and its colleagues in India, Bangladesh, Pakistan and Malaysia are collaborators with the University of Edinburgh in the NIHR Global Health Research Unit on Respiratory Health (RESPIRE).
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On 12 November, RESPIRE colleagues across the globe marked World Pneumonia Day 2019. In Pakistan, Maternal Neonatal and Child Health Research Network (MNCHRN) delivered awareness raising activities in schools, in collaboration with the Pakistan Ministry of Health and Ministry of Education.
RESPIRE member, Dr Senjuti Saha from Child Health Research Foundation (CHRF) in Bangladesh, was recognised on this year’s ‘PneumoniaFighters!’ list, compiled by JustActions. Produced each year, the list recognises ten hidden heroes on the frontline of the fight against pneumonia.
See @RESPIREGlobal for all the action from World Pneumonia Day 2019
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Breathe Well: Building Research across the World in Lung Disease
The NIHR Global Health Research Group on Global COPD in Primary Care managed by the University of Birmingham "Fostering research in primary care and the community to improve the diagnosis, management and prognosis of COPD patients in low and middle income countries.
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Training continues with the overseas partners. The North Macedonian team spent a productive and enjoyable week at the University of Birmingham to participate in qualitative and other research training. Other teams will be arriving in the New Year to learn more analysis. IPCRG is now taking a prominent role in stakeholder engagement and teams are working with Sian Williams, Jaime Correia de Sousa and Corina de Jong to develop their engagement strategies. Here are some snapshots from the IPCRG country members involved:
Brazil
Dr Sonia Martins and Prof Rafael Stelmach are managing a cross-sectional study to evaluate the test accuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD amongst patients with systemic arterial hypertension. They have recruited 1,218 patients and begin the analysis shortly. They are also planning a 2nd qualitative study using focus groups to compare the acceptability of and preferences around a physical activity programme for COPD patients with and without depression and/or anxiety.
China
The team led by Profs Chunhua Chi and KK Cheng has recruited 2,255 patients in their study investigating the test accuracy and cost effectiveness of different screening strategies for identifying undiagnosed COPD. They have begun a second mixed methods study with Chinese GPs and COPD patients to explore the acceptability of and preferences around a physical activity programme.
Republic of North Macedonia
Ethical approval has been obtained. The team led by Dr Radmila Ristovska and Asst Prof Katarina Stavrikj are nearly finished recruiting patients to a randomised controlled trial focused on the promotion of smoking cessation in the community and is based in over 30 GP practices. The target sample size is 1,366 and they have already recruited over 1,000 to the trial.
Georgia
The chief investigators Prof Tamaz Maglakelidze and Prof Ivane Chkhaidze with Dr Mariam Maglakelidze and Dr Nino Maglakelidze have completed a randomised controlled feasibility trial to determine the effectiveness on health related quality of life of a culturally adapted pulmonary rehabilitation programme compared to usual care for patients with symptomatic COPD. They are also working on a qualitative study with Georgian GPs to explore the diagnosis and management of COPD.
Prof Tamaz was recently featured on Georgian TV to speak about pulmonary rehabilitation and our collaborative projects for World Lung Day.
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Research Updates - Other Initiatives
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Research Prioritisation
Thanks to all of you who have signed up to contribute to our new research prioritisation exercise, using an on-line survey, an evidence check and a Delphi method to reach consensus. When this exercise is complete, IPCRG will update its last IPCRG Research Needs Statement, which was published in 2012. This will help IPCRG undertake and advocate for research that addresses unanswered questions that are of importance to primary care clinicians.
We received over 600 potential research questions from 27 countries. Rachel Jordan, Chair of the Research Sub-committee and Arwa Abdel-Aal, Clinical Research Fellow in Primary Care, have worked with a panel of experts to reduce and refine the questions and they are currently being prepared in an online format ready for the first Delphi round.
They will be presented to the participants soon for rating in discrete and manageable sections. We would be most grateful if you could prioritise this work when you receive the email; please remember that you may leave and resume the survey at any time but the sooner we receive the answers then the sooner we can proceed to the next and final rounds, ready for analysis.
In addition to the above steps, Rachel and Arwa have qualitatively analysed all responses from participants and will publish a parallel article that includes themes of important issues relevant to respiratory primary care.
Many thanks again for your help in this important work.
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| Have you heard about our social movement approach to engaging our communities in discussion about the right care for people with asthma? If not, now's the time to engage! |
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Our first Teach the Teacher programme for international community pharmacist leaders took place in Porto in October and was very well received. Another pharmacy Teach the Teacher is being planned for Latin America in 2020.
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Our delivery teams continue to spread the Asthma Right Care message in innovative ways and we are taking Asthma Right Care into new countries, including Greece, Brazil and China.
See www.ipcrg.org/asthmarightcare and @asthmarightcare for news and let us know if you are keen to get involved.
IPCRG has received funding from AstraZeneca to develop our Asthma Right Care Initiative.
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Please share this newsletter with your colleagues and community.
Ioanna Tsiligianni Siân Williams
President IPCRG CEO IPCRG
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Save the Date
The IPCRG 10th World Conference will be in Dublin 28-30 May 2020
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