Why
Asthma?
The
prevalence of asthma has increased in recent years, with over two
million (11%) Australians affected, including:
- one in four primary school children
- one in seven adolescents
- one
in ten adults
Asthma is a major cause of school
absenteeism, child emergency department attendance and admission to
hospital. More than 60,000 Australians are admitted to hospital annually
due to asthma. Up to 60% of asthma deaths may be
associated with avoidable factors. Asthma was included as a National Health
Priority Area in 1999 in recognition of the significant burden it places
on the Australian community (NHPA
website).
Impact
of Cochrane on health care - Australia and beyond
Australia
Management of Asthma in Australia
has been informed by a strong evidence base. Australia's consensus
treatment guidelines for asthma, the Asthma Management Handbook,
draws on the findings of 35 Cochrane reviews and has been used as the
basis for the Federally funded Asthma 3+ Visit Plan.
The following documents provide examples of the
potential of
embedding Cochrane reviews in policy making processes, and may provide a
model that could be implemented in other areas of healthcare:
The Asthma
3+ visit plan
The Asthma
3+ Visit Plan is a Federal Government funded initiative to improve
the management of moderate to severe asthma in general practice
settings. Incentives for general practitioners to implement the
plan are provided through the Practice
Incentive Program. Three years of
funding was provided for this initiative in the 2001 Federal budget.
The plan is based
on a partnership between GP and patient in which diagnosis, development of a written action plan
and education and review are covered in three consultations (or more). The plan was developed and evaluated by
the National Asthma Council. Adapted from the Six Step Asthma
Management Plan, it draws on the findings of Cochrane
reviews and other sources.
Reviews that have
have been used to develop this plan include:
The National
Asthma Action Plan 1999-2002
The National
Asthma Action Plan 1999-2002 was produced as part of the National
Health Priority Initiative to set targets for national asthma activity.
It has 6 key strategies and explicitly requires
evidence-based approaches:
-
Development of
agreed national guidelines and tools for asthma management,
prevention and early diagnosis based on evidence and consumer
needs
-
Wide
dissemination and evidence-based implementation of guidelines and
tools
-
Integration of
care based on guidelines, tools and consumer needs
-
Evaluation of
the processes used to develop, disseminate and implement
guidelines and tools
-
Extension of
understanding and knowledge of asthma through research and access
to quality information
The Asthma
Management Handbook
The Asthma
Management Handbook
2002, produced by the National Asthma
Council, cited 35 asthma reviews from The Cochrane Library.
The Handbook's recommendations are based on the most
up-to-date evidence available sourced from 1999
Evidence-Based Review of the Australian Six Step Asthma Management
Plan, subsequent Cochrane reviews and other meta-analyses.
The Evidence-Based
Review of the
Six Step Asthma Management plan provides one of the clearest examples
of how Cochrane reviews can be used to inform health care policy and clinical
practice.
1999
Evidence-Based Review of the Australian Six Step Asthma Management
Plan
The 1999
Evidence-Based Review of the Australian Six Step Asthma Management
Plan, conducted by Jennifer Coughlan, Amanda Wilson and Peter
Gibson for the NSW Health Department, demonstrates
the full potential of embedding Cochrane reviews in policy making
processes.
The reviewers:
- Developed
and prioritized 150 questions relevant to the Australian Asthma
Management Plan (now the Asthma Management Handbook)
- Used
existing Cochrane reviews to answer questions
- Published
five
new Cochrane reviews to answer questions
- Generated
a list
of priority questions which they sent to the Cochrane Airways Review
Group and resulted in production of seven new
reviews
- Generated
a set
of clinically important questions where
there were gaps in primary research
Examples
of Cochrane reviews used in the review of the Asthma Management
Plan include:
These
reviews appear in the "Summaries of
Cochrane reviews" report published on this site.
International
Thirty
one
different Airways Group reviews were cited in the updated British
Guideline on the Management of Asthma which represents nearly 45% of
asthma reviews on The Cochrane Library.
The
Guideline was updated using evidence based methodology and was produced
jointly by the British Thoracic Society (BTS) and The Scottish
Intercollegiate Guidelines Network (SIGN) in collaboration with the
National Asthma Campaign, the Royal College of Physicians of London, the
Royal College of Paediatrics and Child Health, General Practice Airways
group, and the British Association of Accident & Emergency Medicine.
(source: Arnold
EM, Cates CJ, Lasserson TJ, Malouf R, Tracy S Airways Group . In: The
Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley &
Sons, Ltd.)
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