IV. IPCRG

Primary care guidelines

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1. Levy et al. Diagnosis of respiratory diseases in primary care
   (Levy ML, Fletcher M, Price DB, Hausen T, Halbert RJ, Yawn BP. International Primary Care Respiratory Group (IPCRG) Guidelines: diagnosis of respiratory diseases in primary care. Prim Care Respir J. 2006;15:20-34)
   

   What it adds:

   • Symptom-based (rather than diagnosis-based) approach
   • Recommendations written from the perspective of primary care by primary care physicians
   • Differential diagnosis of chronic respiratory diseases
   • Practical tools: Questionnaires & Diagnosis Guides by age groups
   • Diagnostic algorithms by age group:
   1. < 6 yrs
   2. 6-14 yrs
   3. 15-39 yrs
   4. ≥40 yrs


2. van der Molen et al. Management of asthma
   (van der Molen T, Ostrem A, Stallberg B, Ostergaard MS, Singh RB. International Primary Care Respiratory Group (IPCRG) Guidelines: management of asthma. Prim Care Respir J. 2006;15:35-47)
   
   What it adds:
   
   
   • Discussion of two age groups : adults & preschoolers (<6 yrs)
   • Lists of treatment goals
   • Recommendations on managing asthma exacerbations



3. Price et al. Management of allergic rhinitis
   (Price D, Bond C, Bouchard J, Costa R, Keenan J, Levy ML, et al. International Primary Care Respiratory Group (IPCRG) Guidelines: management of allergic rhinitis. Prim Care Respir J. 2006;15:58-70)
   
   What it adds:
   
   
   • Emphasis on the link between asthma and allergic rhinitis
   • Guide to therapy based on classification of allergic rhinitis
   • Comprehensive guide to available treatments for allergic rhinitis
   • Practical advice on clinical management of allergic rhinitis, associated ocular symptoms, and comorbid asthma

• Consideration of the patient’s perspective
  (ARIA methods paper [Brozek JL et al. Allergy. 2008;63:38-46] specifically states, “Finally, sparse data on how patients value the outcomes and what are patient preferences for recommended interventions is an additional limitation inherent to most clinical practice guidelines.”)
• List of patient-related determinants of poor control:
• Patient expectations, aspirations and goals
• What level of control do patients want to achieve
• Patient goals and asthma control
• Patient adherence to treatment & other aspects of self-management
• Patients’ common sense beliefs about Rx & perceptions of asthma
• Three implications for health-care professionals include the need
• For simple tools to assess and monitor asthma control
• To identify the patient-related reasons for poor control
• To incorporate patient perspectives into the routine review of asthma in primary care

Ongoing work to draft principles for instruments to understand the patients' perspective

Ongoing work reporting a September 2007 meeting in Aberdeen to discuss and draft a set of principles for primary care that describe what sort of instruments are required to understand the patients' perspective, and secondly, what options there are for action

What it will add:

• Discussion of potentially modifiable reasons for poor asthma control:
• wrong diagnosis
• incorrect choice of inhaler, poor technique
• nonadherence to treatment
• individual variation in response to treatment
• smoking
• comorbid rhinitis
• Strategies to develop tools to identify each of these potential reasons for poor asthma control.