Effecting change in primary care management of respiratory conditions: a global scoping exercise and literature review of educational interventions to inform the IPCRG's E-Quality initiative.

This discussion paper describes a scoping exercise and literature review commissioned by the International Primary Care Respiratory Group (IPCRG) to inform their E-Quality programme which seeks to support small-scale educational projects to improve respiratory management in primary care. Our narrative review synthesises information from three sources: publications concerning the global context and health systems development; a literature search of Medline, CINAHL and Cochrane databases; and a series of eight interviews conducted with members of the IPCRG faculty. Educational interventions sit within complex healthcare, economic, and policy contexts. It is essential that any development project considers the local circumstances in terms of economic resources, political circumstances, organisation and administrative capacities, as well as the specific quality issue to be addressed. There is limited evidence (in terms of changed clinician behaviour and/or improved health outcomes) regarding the merits of different educational and quality improvement approaches. Features of educational interventions that were most likely to show some evidence of effectiveness included being carefully designed, multifaceted, engaged health professionals in their learning, provided ongoing support, were sensitive to local circumstances, and delivered in combination with other quality improvement strategies. To be effective, educational interventions must consider the complex healthcare systems within which they operate. The criteria for the IPCRG E-Quality awards thus require applicants not only to describe their proposed educational initiative but also to consider the practical and local barriers to successful implementation, and to propose a robust evaluation in terms of changed clinician behaviour or improved health outcomes.

Knowledge and information and the quality framework.

BACKGROUND: The quality framework developed by The Royal Australian College of General Practitioners is described by Booth in this issue of Australian Family Physician. This article applies the framework to the 'knowledge and information' domain. OBJECTIVE: This article draws on selected examples of immediate relevance to Australian general practitioners to demonstrate the value of such a framework. DISCUSSION: The framework provides a mechanism for assessing policy and implementation initiatives in an Australian context that takes account of the realities of clinical practice. Management, implementation of guidelines, immunisation, electronic prescribing, and decision support are considered using descriptive or analytical approaches.

A woman with asthma: a whole systems approach to supporting self-management.

A 35-year-old lady attends for review of her asthma following an acute exacerbation. There is an extensive evidence base for supported self-management for people living with asthma, and international and national guidelines emphasise the importance of providing a written asthma action plan. Effective implementation of this recommendation for the lady in this case study is considered from the perspective of a patient, healthcare professional, and the organisation. The patient emphasises the importance of developing a partnership based on honesty and trust, the need for adherence to monitoring and regular treatment, and involvement of family support. The professional considers the provision of asthma self-management in the context of a structured review, with a focus on a self-management discussion which elicits the patient's goals and preferences. The organisation has a crucial role in promoting, enabling and providing resources to support professionals to provide self-management. The patient's asthma control was assessed and management optimised in two structured reviews. Her goal was to avoid disruption to her work and her personalised action plan focused on achieving that goal.

IPCRG Consensus statement: tackling the smoking epidemic - practical guidance for primary care.

Tobacco use will become the world's foremost cause of premature death and disability within 20 years unless current trends are reversed. Many opportunities to reduce this epidemic are missed in primary care. This Discussion paper from the International Primary Care Respiratory Group (IPCRG) - which reflects the IPCRG's understanding of primary care practitioners' needs - summarises a new approach based on strong evidence for effective interventions. All primary care health professionals can increase smoking cessation rates among their patients, even when time and resources are limited. Medical and non-medical staff can support patients who choose to quit by providing information, referral to telephone counselling services, and behavioural counselling using motivational interviewing techniques, where resources permit. Drug therapy to manage nicotine dependence can significantly improve patients' chances of quitting successfully, and is recommended for people who smoke 10 or more cigarettes per day. All interventions should be tailored to the individual's circumstances and attitudes.

The impact of the UK General Practice Airways Group (GPIAG) - an international perspective.

The impact of the UK General Practice Airways Group (GPIAG) over the past 20 years is discussed from an international perspective. The formation of the International Primary Care Respiratory Group (IPCRG) following the GPIAG conference in 2000, and the role of the Primary Care Respiratory Journal in publishing high quality primary care respiratory research, have been seminal elements in the development of the discipline of primary care respiratory medicine internationally. Research, guidelines development, education, and advocacy, are other areas where the GPIAG has provided a model or shown the way. At a more pragmatic level, the experience of the GPIAG in building a relationship with sponsors and in negotiating the regulatory maze in order to establish an incorporated legal company and charity saved the IPCRG much anguish. The differing roles of national and international organisations are contrasted to illustrate the constructive tension that has impacted on both organisations over the past five years. The IPCRG has built on the foundations of national organisations, particularly the GPIAG, but is charting the way internationally to support the delivery of better health outcomes for people with respiratory disease.

International Primary Care Respiratory Group (IPCRG) Guidelines: dissemination and implementation--a proposed course of action.

There is growing evidence that good implementation of evidence-based guidelines can result in improvement in health outcomes. This paper on Dissemination and Implementation constitutes the final paper of the IPCRG Guidelines on the management of chronic respiratory diseases in primary care. It highlights the historical development of these guidelines following the formation of the International Primary Care Airways Group (IPAG) in 2001 together with its dissemination and implementation subgroup, and the subsequent transfer of this dissemination and implementation role to the IPCRG. It covers the main factors within the IPCRG workplan, including the issues of governance, launch, dissemination, implementation, and evaluation.