The new 2018 National Asthma Strategy calls for major changes in areas where there are big gaps between evidence and practice, such as such as underuse of asthma management plans.
The roadmap, launched this week by the National Asthma Council, outlines five key goals which including more support for patient self management practices and workforce reforms to allow allied health professional such as nurses to provide more asthma care.
With most asthma patients missing out on written action plans, one suggestion is to extend medical provider status to asthma educators and allow practice nurses to prepare asthma action plans that are currently restricted to GPs.
Other recommendations include the adoption of new discharge protocols to better identify and manage frequent users of hospital asthma services, and revised guidelines to address asthma in high risk patients such as those with drug and alcohol problems.
The strategy also calls for a review of Medicare incentives and team care arrangement to assess whether they are having any impact on asthma management.
There is also a need for a unified approach to Australian research into asthma, the strategy document argues, noting that current research is unco-ordintaed and polarised between research groups seeking ‘cures’ and others seeking solutions to reduce the burden of disease.
NAC chairman Dr Jonathan Burdon told the limbic that the new strategy identified areas of asthma where the potential for impact was greatest, such as achieving better adherence to preventer inhalers.
“Increasing the uptake of asthma action plans for adults and children is [also] a focus, as we strive to achieve the biggest gains in improving patient quality of life, and reducing asthma morbidity and its associated costs,” he said.
However despite the strategy calling for better education and training programs for patient and health professional, Dr Burdon acknowledged that asthma groups were facing “disappointing” funding cuts under government austerity that threatened cuts to support services.
This meant that groups such as the NAC had to look elsewhere for funding for asthma support programs and also to implement the strategy as a whole, he said
“This is a wishlist, if you like. Now we have to go out there and make it happen,”.
The strategy was developed in partnership with Asthma Australia and funded by the Department of Health.
At the official launch on 31 January, federal Minister for Health Greg Hunt said the government would allocate an additional $1 million to asthma education programs for schools. However, as reported previously in the limbic, Asthma Australia says it is facing a $4.7 million government funding cut by 2019, which it says will decimate support services including asthma education programs for 12,000 children.
The National Asthma Strategy identifies 11 current problems in asthma that must be addressed by the new strategy:
- No single reliable (‘gold standard’) diagnostic test for asthma.
- Frequent under- and over-diagnosis of asthma due to poor diagnostic accuracy.
- Spirometry underused in general practice due to lack of training in use and interpretation of results.
- Poor self-management practices, such as correct inhaler use.
- Primary care nurses and pharmacists lack opportunities to provide asthma self-management advice.
- Asthma action plans can only be signed off by GP who is too busy.
- Only half of people with asthma see their GP for the recommended annual non-urgent review.
- Overprescribing of ICS/LABA preventer inhalers when less expensive lower-dose inhaled corticosteroids are more appropriate.
- Preventer medications prescribed for many people who do not have asthma.
- Only 40% of children and 25% of all people with asthma have an asthma action plan.
- Lack of asthma services for Aboriginal and Torres Strait Islander people.