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The Founding of the International Primary Care Respiratory
Group (IPCRG)
Thys van der Molen and David Price
Summary
During the First International Primary Care Respiratory Conference hosted by the UK GPIAG (General Practice Airways Group) in Cambridge, the International Primary Care Respiratory Group (IPCRG) was founded. The aims of the Group are the support and co-ordination of respiratory research in primary care, the ongoing education of primary health care providers in the field of respiratory diseases and the development of guidelines for and by primary healthcare providers. This will be achieved largely through collaboration with and support for local primary care respiratory interest groups. The next international meeting will be held in Amsterdam the Netherlands in June 2002 followed by Australia in 2004. Professor Thys van der Molen (Groningen in The Netherlands, and Aberdeen in Scotland) has been elected the first chairman of the IPCRG. He will lead the group until the meeting in 2002. Thereafter Dr John Fardy from Australia and Professor Jim Reid from New Zealand will take over, in order to organize the Australian meeting.
With the founding of the International Primary Care Respiratory Group (IPCRG) a remarkable milestone has been reached. The IPCRG was formed by consensus with representatives from over 15 countries attending the first international primary care respiratory conference.
The aim of the IPCRG is to support primary care
health workers in their treatment of patients with respiratory diseases. It will do so through National Primary Care Respiratory Groups such as the GPIAG (General Practice Airways Group) in the UK; the CAHAG (CARA Huisartsen Groep; Chronic Obstructive Lung Disease General Practitioners Group) in the Netherlands; the FPAGC (Family Physician Asthma Group of Canada) in Canada; the GPAG (General Practitioners Asthma Group of the Australian National Asthma Council) in Australia; the Irish General Practitioner Group (IGPG); and similar groups in other countries including New Zealand, Denmark, France, Norway and Sweden.
Respiratory diseases, in particular asthma and COPD, are very common diseases and are a significant burden to healthcare systems comprising a large component of both acute and chronic workload.1,2,3 Although the prevalence of asthma and COPD differs between countries and within countries, epidemiological studies suggest that between 5 and 15% of all people suffer from asthma and or COPD.
Respiratory diseases, in particular asthma and COPD,
are very common diseases and are a significant burden
to healthcare systems comprising a large component of
both acute and chronic workload.1,2,3 Although the
prevalence of asthma and COPD differs between
countries and within countries, epidemiological studies
suggest that between 5 and 15% of all people suffer
from asthma and or COPD.
Other respiratory diseases such as tuberculosis have a
high prevalence in a number of countries, whereas
these diseases are relatively uncommon in highly
developed countries with easy access to good quality
health care.4
With the high prevalence of most respiratory diseases,
it is not surprising that they are also very common in
the practice of primary care physicians and primary
care-based nurses. In some countries the respiratory-related consultations referred to as ’R’ consultations in
the International Classification of Diseases (ICD), in
busy primary care practices may equal or exceed the
number of outpatient consultations of a pulmonary
specialist in a general hospital.
With the large number of general practitioners and
other primary care workers in contrast to the very limited number of trained respiratory specialists, it is clear that the majority of patients with respiratory diseases will be and should be treated in primary care. The evidence for the efficiency and cost-effectiveness of primary care-based treatment, of patients with asthma and COPD in countries with strong primary health-care systems, is overwhelming.5 Primary care in these countries undertakes the vast majority of respiratory health care.6 This has real advantages for patients who have easy and almost instant access to a health-care provider in the neighbourhood and, in the countries with stable patient lists, access to a well-known provider.
That patients who have a chronic disease requiring chronic management profit from such a situation appears obvious. In 1996 a group of researchers in uptown Manhattan reported hospital admission rates up to 1003 per 100,000 for asthma alone7 compared with rates of approximately 400 per 100,000 in the UK.8 Although there certainly are differences in definitions and culture, these data emphasize the ’real-life’ effectiveness for patients with less severe exacerbations in countries that provide stable easy access to primary health care and maintenance control of chronic diseases.
It is therefore a very important development that general practitioners and other primary healthcare workers recognize their role in the treatment of patients with respiratory diseases and organize themselves around this subject. One of the organizations that is extremely successful is the UK-based General Practice Airways Group (GPIAG, formerly known as the GPs in Asthma Group). Other countries have similar or related organizations each with their own agenda based on improving primary care for patients with respiratory disease.
The first target we have set for the IPCRG is to organize an international, primary care respiratory conference, every 2 years, where the best of primary care respiratory research can be presented along with major workshops about asthma, COPD, lung cancer, rhinitis, smoking cessation and respiratory infections. The first IPCRG conference will be held in June 2002 in Amsterdam.
A second major aim of the IPCRG will be to support national groups in their efforts to obtain funds for research and, it is to be hoped, co-ordinate international research projects. Research is one of the basic elements in providing evidence-based health care. Although more than 80% of respiratory disease management is provided by primary health care around the world, primary care has had only very limited access to research funding; the bulk of which is spent in hospital settings. The results of this research are often then extrapolated to primary care. However, evidence based on research in hospital settings is not necessarily valid in the family practice setting.
The third important issue for the IPCRG will be to support the development of local guidelines for the management of respiratory diseases. Many guidelines currently exist, the majority based on evidence derived from secondary care with guideline committees drawn from the same background. If a guideline committee includes a primary care physician or nurse in their board, he or she will be truly outnumbered by hospital-based clinicians and clinical inactive scientists.9
Guidelines should be made by those who will be using them.10 Local circumstances and local active health-care workers should influence the development of local guidelines to an extent that makes these guide-lines workable for them.
To achieve these aims the International Primary Care Respiratory Group will attempt to put primary care development in the treatment of respiratory diseases on the agenda of many organizations related to respiratory care.
With the internationalization of the local groups, we should be able to organize the 2-yearly conferences, be a serious partner in research and the main partner in the development of new and easy-to-apply guidelines. The membership will be the national groups committed to primary care respiratory management. Organization will be steered by members from all participant countries and will be chaired by a member of the nation that will organize the next international meeting. Co-chair will be a member of the nation that organizes the subsequent international meeting. The first President is Thys van der Molen Associate Professor of General Practice in Groningen, the Netherlands and visiting Professor of General Practice and Primary Care in Aberdeen, Scotland. The next international meeting is planned for June 2002 and the subsequent one for 2004 in Australasia which Dr John Fardy from Australia and Professor Jim Reid from New Zealand will chair. The International Primary Care Respiratory Group steering committee will have its first meeting during the ERS conference in Florence in order to put the first steps in place for the realization of the aims as stated above.
References
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2. Christie GL, Helms PJ, Godden DJ et al. Asthma, wheezy bronchitis, and atopy across two generations. Am J Respir Crit Care Med 1999:159:125–9.
3. von Mutius E, Martinez FD, Fritzsch C, Nicolai T, Roell
G, Thiemann HH. Prevalence of asthma and atopy in two areas of West and East German. Am J Respir Crit Care Med 1994;149:358–64.
4. Tocque K, Bellis MA, Tam CM et al. Long-term trends in tuberculosis. Comparison of age-cohort data between Hong Kong and England and Wales. Am J Respir Crit Care Med 1998;158:484–8.
5. Wever-Hess J, Wever AM, Yntema JL. Mortality and morbidity from respiratory diseases in childhood in The
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6. Dickinson J, Hutton S, Atkin A et al. Reducing asthma
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7. De Palo VA, Mayo PH, Friedman P, Rosen MJ.
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8. Lung & Asthma Information Agency. Trends in hospital
admissions for asthma. Factsheet 96/2.
9 The British Thoracic Society, The National Asthma
Campaign, The Royal College of Physicians of London in
association with the General Practitioner in Asthma Group, the British Association of Accident and Emergency Medicine, the British Paediatric Respiratory Society and the Royal College of Paediatrics and Child Health. The British guidelines on asthma management 1995 review and position statement. Thorax 1997;52(Suppl 1):S1–S20.
10. Geijer RMM, Van Hensbergen W, Bottema BJAM et al.
NHG-Standaard Astma bij Volwassenen: Behandeling.
Huisarts Wet 1997;40:443–54.
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