Barriers to self-managementasthma child inhaler180

Asthma management is still the hot potato it was back in 2011 when we looked at the role of community pharmacies and the introduction of the HDWA Asthma Action Plan card. Research back then showed that pharmacies were not referring patients appropriately and patients and GPs were not using the cards distributed by pharmacies. Fast forward and UWA Pharmacy PhD candidate Ms Kim Watkins is midway through evaluating those programs and asthma management in community pharmacy to find out what can be done better. She told Medical Forum her focus groups with asthma patients, GPs, practice nurses, pharmacists, pharmacy assistants and asthma educators were an eye-opener. There were more barriers to leap than the Grand National. The development of diagnostic tools and guidelines is not enough. As Kim says, there is more to be done than ‘here’s the tool and guidelines, get on with it. We need to look more specifically at the barriers to best practice.’ A vital key is collaboration.

Asthma still a killer
The Australian Institute of Health and Welfare’s (AIHW) report last month showed the death rate from asthma had fallen by almost 70%, but it was still relatively high on an international scale – there were 378 deaths in 2011. The same year, COPD was the underlying cause of 5767 deaths of people aged 55 and over. As Kim Watkins’ research is finding (see above), asthma sufferers fail to take their condition seriously and often wait too long to seek treatment. NPS MedicineWise, spruiking its e-Audit to GPs, claims patients with a current written asthma action plan have around 40% fewer hospital admissions. It adds, however, that only 18% of those diagnosed with asthma have an action plan written by a doctor. Combine that with the report in the Australian Asthma Handbook 2014, which reckons that up to 90% of Australians with asthma don’t use their inhaler correctly, the picture is not pretty.

Birth defects sober
A close look at the WA Register of Developmental Anomalies since 1980 is sobering. For every 1000 children born in WA, about 45 will have birth defects (more males; multiple pregnancies) – among them, about 18 will have musculoskeletal (e.g. hip dysplasia) problems; 10 urogenital (e.g. hypospadias), 1 neural tube (e.g. hydrocephalus), and 1 Down syndrome. Down syndrome rates have slowly increased since 1980 and for every child born with this chromosomal abnormality today, about four pregnancies are terminated. Amongst stillbirths and neonatal deaths, birth defects affect 8.1% and 27.7%, respectively, while fetal anomaly were the reason for terminating 0.66% of pregnancies. About a quarter of cases have more than one defect. On top of this, cerebral palsy birth prevalence rates are about 2.3 per 1000 live births, with most children having mild motor impairment and just under half having intellectual disability.

ConferencePlaceSetting2160Where next for MA Code?
The deadline for submissions on whether the ACCC should authorise the new edition of MA’s Code of Conduct has closed and support has been anything but overwhelming. There were 47 submissions, 40 against acceptance of v18 of the Code because: not enough transparency; too slow to move; no tangible public benefit in changes; no single source tracking that amalgamated sponsorship for particular providers; no disclosure of sponsorship of research and clinical trials; not disclosing sponsored individuals was unethical; MA ignored work of its own Transparency Working Group; not happy with use of starter packs; health organisations not part of disclosure; those non-compliant with disclosure can still receive benefit; erosion of professional integrity; should include non-prescription items; and sponsorships below a threshold are not accumulative when it comes to declaration. Submissions came from 28 individuals as well as Choice, RANZCP, Consumers Health Forum, Pharmacy Guild, Pharmaceutical Society, Society of Hospital Pharmacists, Medicines Australia, Cancer Voices Australia, SA Medicines Advisory Committee and RACGP.  A notable ‘yes’ tick for the proposed Code came from the federal AMA, which said there was no evidence that disclosures helped health consumers; and most practitioners would comply because when companies asked doctors for “usual disclosure” this would scare them off. Also amongst the seven submissions endorsing the code in its current form were GSK, Australian Practice Nurses Association, Pfizer, and MSD.

Funding cracks PCWA
It was born from the ashes of the WA GP Network and it had hoped to become a hub for the many organisations that constitute primary care. Primary Care WA had 37 groups involved and the membership included NGOs, Medicare Locals and consumer groups. However, in March, after 18 months of trying and failing to secure steady funding, the board decided to wind up PCWA, a process which chairman Mr Dan Minchin says is almost complete. Any surplus funds, which he says will be minimal, will be distributed to ‘a like-minded organisation’ in accordance with the PCWA constitution.

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