PACE Australia Intervention


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American Thoracic Society (ATS) Annual Meeting 2011

Dr Smita Shah
Director, Primary Health Care Education and Research Unit
Primary Care and Community Health Network
Clinical Senior Lecturer, School of Public Health
Western Clinical School, Poche Centre for Indigenous Health
The University of Sydney, Australia

Published in: Health & Medicine
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  • Thank you My paper today is reporting on our experience
  • First a little about Australia. Australia and the US are of a similar size , but the US population is fifteen times that of Australia’s 20 million Majority of Australians live along the East coast in cities like Melbourne, Brisbane and Sydney. I live and work in Sydney, which is Australia’s largest city, with a population of nearly 4million
  • Suggested script The PACE Australia Project is funded by the Department of Health and Ageing. The project has no commercial sponsorship from pharmaceutical companies .
  • Suggested script Today we will have the first of the two sessions and this will broadly cover clinical aspects of asthma and communication strategies. In particular we will cover….
  • Suggested script The second session will be held on Saturday September 8 th . This will focus on the broad topic of patient education. We will begin the 2nd session with questions or your own cases for discussion. Then we will hear from you about how you went trying out some of the communication strategies and your use of the self rating questionnaire – yes you have some homework to do between the first and second seminar – but we will come to that later!!! There will be a video demonstration of patient education, a discussion on asthma management plans and case studies. We will briefly present the new Asthma Cycle of Care. Finally we will have a hands-on and fun session for you to learn how to use devices and then to teach your patients the correct use of the various asthma delivery devices.
  • Suggested script In this folder which you will receive later in the workshop you should have - a copy of the slides - so you don’t have to take too many notes - copies of any educational materials to which a speaker might refer - and also educational material for you to use in your practice.
  • PACE Australia Intervention

    1. 1. Dr Smita Shah Director, Primary Health Care Education and Research Unit Primary Care and Community Health Network Clinical Senior Lecturer, School of Public Health Western Clinical School, Poche Centre for Indigenous Health The University of Sydney, Australia Susan Sawyer, Brett Toelle, Craig Mellis, Jenny Peat, Marivic Lagleva, Tim Usherwood, Christine Jenkins PACE Australia Intervention
    2. 2. Australia
    3. 3. <ul><li>Population: 3.2 million </li></ul>Sydney
    4. 4. Overview <ul><li>PACE Australia program </li></ul><ul><li>How the program differs from the original </li></ul><ul><li>Australian RCT study results </li></ul><ul><li>Dissemination </li></ul>
    5. 5. PACE Australia partners <ul><ul><li>Western Clinical School, University of Sydney </li></ul></ul><ul><ul><li>Woolcock Institute of Medical Research, Sydney </li></ul></ul><ul><ul><li>Centre for Adolescent Medicine, Royal Children’s Hospital, Melbourne </li></ul></ul><ul><ul><li>University of Michigan, USA </li></ul></ul>Funded by the Australian Government Department of Health & Ageing
    6. 6. Phase 1: 2003-04 <ul><li>Collaboration with N Clark and M.Cabana </li></ul><ul><li>Steering committee established </li></ul><ul><li>Program modified to the Australian context and current evidence </li></ul><ul><li>Practitioner Asthma Communication & Education (PACE) Australia </li></ul>
    7. 7. Program comparison <ul><li>Similarities </li></ul><ul><li>Program framework </li></ul><ul><li>10 Communication strategies </li></ul><ul><li>10 Education messages </li></ul><ul><li>Video </li></ul><ul><li>Small group format </li></ul><ul><li>Expert presenters </li></ul><ul><li>Differences </li></ul><ul><li>Patterns of asthma </li></ul><ul><li>Asthma medications </li></ul><ul><li>Writing action plans </li></ul><ul><li>Australian remuneration </li></ul><ul><li>Teaching asthma devices </li></ul><ul><li>More interactive </li></ul>
    8. 8. PACE Australia Session 1 <ul><li>Clinical aspects </li></ul><ul><li>Patterns of asthma </li></ul><ul><li>Case studies </li></ul><ul><li>Asthma medications </li></ul><ul><li>Asthma Action Plans </li></ul><ul><li>Communication strategies </li></ul>
    9. 9. PACE Australia Session 2 <ul><li>Q&A </li></ul><ul><li>Self-Rating Scale </li></ul><ul><li>Patient education DVD </li></ul><ul><li>Case studies </li></ul><ul><li>Asthma Cycle of Care </li></ul><ul><li>Asthma devices </li></ul>
    10. 10. PACE Australia Doctor’s Kit <ul><li>Copy of slides </li></ul><ul><li>Asthma Action Plans </li></ul><ul><li>Communication & education strategies </li></ul><ul><li>NAC Asthma Management Handbook </li></ul><ul><li>‘ Airways’ </li></ul><ul><li>Samples of asthma devices </li></ul>
    11. 11. <ul><li>25 GPs </li></ul><ul><li>Evaluation </li></ul><ul><ul><li>To measure change in doctors communication behaviour </li></ul></ul><ul><ul><li>To obtain feedback about the program and identify its acceptability for more robust testing of the program with Australian GPs </li></ul></ul>Phase 1: Feasibility study
    12. 12. Results <ul><ul><li>Program content and interactivity rated very highly </li></ul></ul><ul><ul><li>Most useful components </li></ul></ul><ul><ul><li>communication skills </li></ul></ul><ul><ul><ul><ul><li>patterns of asthma </li></ul></ul></ul></ul><ul><ul><ul><ul><li>devices </li></ul></ul></ul></ul><ul><ul><li>Suggestions </li></ul></ul><ul><ul><li>increase time by 30 mins </li></ul></ul><ul><ul><li>re-make video using Australian actors </li></ul></ul><ul><li>Shah S et al., Australian Journal of Primary Health Care 2010 </li></ul>
    13. 13. GPs - communication behaviours 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
    14. 14. Phase 2: 2005 <ul><li>Development of program resources </li></ul><ul><ul><li>PACE Australia Presenter’s manual </li></ul></ul><ul><ul><li>Train the Trainer program and Manual </li></ul></ul><ul><ul><li>Australian video: Talking Asthma </li></ul></ul><ul><ul><li>RCT funding proposal </li></ul></ul>
    15. 15. <ul><li>Aim </li></ul><ul><li>To measure the impact of PACE on processes, costs and outcomes of GPs management of children with asthma </li></ul><ul><li>Methods </li></ul><ul><li>RCT in primary health care </li></ul><ul><li>Recruitment </li></ul><ul><li>General Practitioners in Sydney </li></ul><ul><ul><li>Children with doctor diagnosed asthma </li></ul></ul><ul><ul><li>Questionnaires (adapted from PACE, USA) </li></ul></ul><ul><ul><ul><li>GPs- self reported questionnaire </li></ul></ul></ul><ul><ul><ul><ul><li>Patients – parent interviews; independent monitor </li></ul></ul></ul></ul><ul><li> </li></ul>Phase 3: 2006 – 2010
    16. 16. PACE Australia Outcomes <ul><li>Primary outcome </li></ul><ul><ul><ul><li>Possession of a written asthma action plan </li></ul></ul></ul><ul><li>Secondary outcomes </li></ul><ul><ul><ul><li>Medication appropriate to pattern of asthma </li></ul></ul></ul><ul><ul><ul><li>Parent/ child days away from work and school </li></ul></ul></ul><ul><ul><ul><li>Use of Asthma Cycle of Care by GPs </li></ul></ul></ul><ul><ul><ul><li>Education of asthma device use </li></ul></ul></ul>
    17. 17. Results Variation in baseline study population PACE USA PACE Australia Target Primary Care Paediatricians General Practitioners Asthma severity Moderate-Severe Mild-Moderate ICS use Suboptimal Inappropriate
    18. 18. Use of ICS by asthma classification
    19. 19. 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
    20. 20. Key differences in results <ul><li>Target population </li></ul><ul><li>Asthma severity </li></ul><ul><li>Different outcomes </li></ul><ul><ul><li>Written Asthma Action Plans </li></ul></ul><ul><ul><li>Patterns of Asthma </li></ul></ul><ul><ul><li>Asthma medications and devices </li></ul></ul>
    21. 21. Dissemination <ul><li>Publication of RCT </li></ul><ul><li>PACE Australia Kit </li></ul><ul><ul><li>Train the trainer manual </li></ul></ul><ul><ul><li>Talking Asthma DVD </li></ul></ul><ul><li>Further research </li></ul><ul><ul><li>Pharmacists/nurses </li></ul></ul><ul><ul><li>Adults with asthma </li></ul></ul><ul><ul><li>Use the methodology for other chronic diseases </li></ul></ul>
    22. 22. RE-AIM / PACE Australia How does PACE Australia fit the RE-AIM framework? Reach High - Individual level Efficacy High – Individual level Adoption ? - organisation Implementation Medium - organisation Maintenance High – individual Organisation –low
    23. 23. Questions <ul><li>How best to take PACE Australia further? </li></ul><ul><li>What is GINA's role for dissemination of evidence-based programs? </li></ul><ul><li>Is there a role for organisations such as ATS/TSANZ play in advocating for funding of evidence-based programs? </li></ul>