Facilitation of optimal asthma management to radically influence health policy in primary care in Ireland

Prior to the initiation of this program guideline based care was not prioritised by health policy. Asthma control is sub-optimal in Ireland; recent primary care data shows 14% of asthma patients attended A&E, 8% hospitalised in the previous 12 months. The Asthma Society of Ireland (ASI) developed a framework for the Dept. of Health and Health Service Executive (HSE) in collaboration with Healthcare Professional (HCP) bodies based on nationally modified guidelines (GINA) and a core program to assess the feasibility of implementing a National Asthma Program. The ASI funded and developed an asthma management program in primary care to identify barriers and facilitators to implementation of guideline based care. 25 primary care teams completed a guideline based educational program and practical training session. Each team was given a tool-kit with spirometer, peak flow meters and diaries, patient education materials, placebo inhalers and spacers. Adherence to guidelines was facilitated with a specifically developed Electronic Patient Record. 778 patients were included in the program for 6 months. A guideline based asthma program can be implemented successfully if practices are provided with necessary resources for diagnosis, management and patient education. HCP agreed guidelines improved patient care (92.7%), facilitated cost effective care (70.7%). Arising from this study HSE has prioritised the development of a National Asthma Program with asthma specific key performance indicators in its service plans. Active collaboration between patient organisations, HCP and health service providers has lead to a fundamental change in asthma health policy in primary care.