Dr Smita ShahDirector, Primary Health Care Education and Research Unit

Primary Care and Community Health NetworkClinical Senior Lecturer, School of Public Health

Western Clinical School, Poche Centre for Indigenous HealthThe University of Sydney, Australia

Susan Sawyer, Brett Toelle, Craig Mellis, Jenny Peat, Marivic Lagleva, Tim Usherwood, Christine Jenkins

PACE Australia Intervention

Australia

Population: 3.2 million

Overview

PACE Australia program

How the program differs from the original

Australian RCT study results

Dissemination

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PACE Australia partners

Western Clinical School, University of Sydney

Woolcock Institute of Medical Research, Sydney

Centre for Adolescent Medicine, Royal Children’s Hospital, Melbourne

University of Michigan, USA

Funded by the Australian Government Department of Health & Ageing

Phase 1: 2003-04

Collaboration with N Clark and M.Cabana

Steering committee established

Program modified to the Australian context and current evidence

Practitioner Asthma Communication & Education (PACE) Australia

Program comparison

Similarities

Program framework

10 Communication strategies

10 Education messages

Video

Small group format

Expert presenters

Differences

Patterns of asthma

Asthma medications

Writing action plans

Australian remuneration

Teaching asthma devices

More interactive

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PACE Australia Session 1

Clinical aspects

Patterns of asthma

Case studies

Asthma medications

Asthma Action Plans

Communication strategies

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PACE Australia Session 2

Q&A

Self-Rating Scale

Patient education DVD

Case studies

Asthma Cycle of Care

Asthma devices

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PACE Australia Doctor’s Kit

Copy of slides Asthma Action Plans Communication & education

strategies NAC Asthma Management

Handbook ‘Airways’ Samples of asthma devices

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25 GPs Evaluation

To measure change in doctors communication behaviour

To obtain feedback about the program and identify its acceptability for more robust testing of the program with Australian GPs

Phase 1: Feasibility study

ResultsProgram content and interactivity rated very highlyMost useful components

communication skills

patterns of asthma

devices Suggestions

increase time by 30 mins

re-make video using Australian actors›

› Shah S et al., Australian Journal of Primary Health Care 2010

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12 months pre workshop

1 month post workshop

Difference P value

Mean “How Confident” score(1= not at all confident to 6 = extremely confident)

4.2 5.03 0.8 < 0.0001

Mean “How Helpful” score(1= not at all helpful to 6 = extremely helpful)

5.0 5.5 0.5 0.01

Mean “How Often” score (1= never to 6 = often)

4.6 5.2 0.6 0.0001

GPs - communication behaviours

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Phase 2: 2005

Development of program resources

PACE Australia Presenter’s manual

Train the Trainer program and Manual

Australian video: Talking Asthma

RCT funding proposal

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Aim To measure the impact of PACE on processes, costs and

outcomes of GPs management of children with asthmaMethods

RCT in primary health careRecruitment

General Practitioners in Sydney Children with doctor diagnosed asthma

Questionnaires (adapted from PACE, USA)GPs- self reported questionnaire

Patients – parent interviews; independent monitor

Phase 3: 2006 – 2010

PACE Australia Outcomes

Primary outcome

Possession of a written asthma action plan

Secondary outcomes

Medication appropriate to pattern of asthma

Parent/ child days away from work and school

Use of Asthma Cycle of Care by GPs

Education of asthma device use

Results

PACE USA PACE Australia

Target Primary Care Paediatricians General Practitioners

Asthma severity

Moderate-Severe Mild-Moderate

ICS use Suboptimal Inappropriate

Variation in baseline study population

Use of ICS by asthma classification

Percent difference between intervention and control group & 95% CI

-40 -20 0 20 40 60 80

Infrequent intermittentsymptoms

Frequent intermittent symptoms

Persistent symptoms

Favours intervention

Favours intervention

P=0.03

P=0.82

P=0.71

Outcomes: NNT

General Practitioners NNT

Completion of asthma cycle of care 3.3

Prescribing a spacer device 3.5

Providing written action plan>70% of time 4.3

Patients

Child with persistent symptoms using ICS 4.0

Child with infrequent symptoms not using ICS 4.2

Written action plan in last 12 months 5.4

Key differences in results

Target population

Asthma severity

Different outcomes

Written Asthma Action Plans

Patterns of Asthma

Asthma medications and devices

Dissemination

Publication of RCT

PACE Australia Kit Train the trainer manual

Talking Asthma DVD

Further research Pharmacists/nurses

Adults with asthma

Use the methodology for other chronic diseases

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RE-AIM / PACE Australia

Reach High - Individual level

Efficacy High – Individual level

Adoption ? - organisation

Implementation Medium - organisation

Maintenance High – individual

Organisation –low

How does PACE Australia fit the RE-AIM framework?

Questions

How best to take PACE Australia further?What is GINA's role for dissemination of evidence-based programs?

Is there a role for organisations such as ATS/TSANZ play in advocating for funding of evidence-based programs?

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