Translation of an evidence-based asthma intervention: Physician Asthma Care Education (PACE) in the United States and Australia

Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA.
Primary care respiratory journal: journal of the General Practice Airways Group (Impact Factor: 2.5). 11/2012; 22(1). DOI: 10.4104/pcrj.2012.00093
Source: PubMed


BACKGROUND: Physician Asthma Care Education (PACE) is a programme developed in the USA to improve paediatric asthma outcomes. AIMS: To examine translation of PACE to Australia. METHODS: The RE-AIM framework was used to assess translation. Demographic characteristics and findings regarding clinical asthma outcomes from PACE randomised clinical trials in both countries were examined. Qualitative content analysis was used to examine fidelity to intervention components. RESULTS: Both iterations of PACE reached similar target audiences (general practice physicians and paediatric patients with asthma); however, in the USA, more children with persistent disease were enrolled. In both countries, participation comprised approximately 10% of eligible physicians and 25% of patients. In both countries, PACE deployed well-known local physicians and behavioural scientists as facilitators. Sponsorship of the programme was provided by professional associations and government agencies. Fidelity to essential programme elements was observed, but PACE Australia workshops included additional components. Similar outcomes included improvements in clinician confidence in developing short-term and long-term care plans, prescribing inhaled corticosteroids, and providing written management instructions to patients. No additional time was spent in the patient visit compared with controls. US PACE realised reductions in symptoms and healthcare use, results that could not be confirmed in Australia because of limitations in follow-up time and sample sizes. US PACE is maintained through a National Heart, Lung, and Blood Institute website. Development of maintenance strategies for PACE Australia is underway. CONCLUSIONS: Based on criteria of the RE-AIM framework, the US version of PACE has been successfully translated for use in Australia.

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    • "RE-AIM consists of five dimensions: Reach: participation rate and representativeness of individuals who are willing to participate in a given programme; Efficacy: the success rate of an intervention on important outcomes, when it is implemented as intended; Adoption: percentage and representativeness of organisations that will begin or adopt a programme; Implementation: quality and consistency of programme delivery when the intervention is implemented as intended in the realword settings; and Maintenance: sustainability of intervention effects on individual's behaviour change, as well as the extent to which a programme becomes institutionalised [14]. The RE-AIM evaluation framework was recently applied to assess the translation of an evidence-based intervention in patients with asthma [15]. It categorises several types of chronic illness self-management interventions in the following modalities: one-to-one in-person counselling, group counselling sessions, telephone calls, interactive computer sessions, mailed print and health system policy. "
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    ABSTRACT: According to practice guidelines, educational programmes for patients with COPD should address several educational topics. Which topics are incorporated in the existing programmes remains unclear. To delineate educational topics integrated in current COPD management interventions; and to examine strengths, weaknesses, and methods of delivery of the educational programmes. A systematic literature search was performed using MEDLINE/PubMed, Cochrane Central Registry of Controlled Clinical Trials, and Web of Science. The authors of included studies were contacted for additional information. Studies that contained educational programmes incorporated in COPD management interventions were included. Data were extracted using a pre-designed data form. The Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework was used for evaluating the strengths and weaknesses of the programmes. In total, 81 articles, describing 67 interventions were included. The majority (53.8%) of the studies incorporated 10 or more educational topics. The following topics were frequently addressed: smoking cessation (80.0%); medication (76.9%); exercise (72.3%); breathing strategies (70.8%); exacerbations (69.2%); and stress management (67.7%). Printed material and/or brochure (90.5%) and demonstrations and practice (73.8%), were the predominant tool and method, respectively. Nurses (75.8%), physicians (37.9%) and physiotherapists (34.8%) were the most involved healthcare professionals. Heterogeneity and wide variation in the content and the method of delivery of educational interventions were present. Alignment between educational topics incorporated in the existing programmes and those recommended by the COPD guidelines, involvement of various professionals and combined use of methods should be emphasised.
    Respiratory medicine 09/2013; 107(11). DOI:10.1016/j.rmed.2013.08.006 · 3.09 Impact Factor
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    ABSTRACT: 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.
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