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Subject: New international guidelines for primary care on managing respiratory problems
Date sent: 11 February 2006



You will be delighted to learn that the IPCRG Guidelines for the Management of Chronic Respiratory Diseases in Primary Care have just been published in the online version of the Primary Care Respiratory Journal Volume 15, Issue 1 - They will also be released in hard copy of the Journal in mid-February. Please find below a copy of the media release which we would be delighted if you could pass on to other respiratory interested colleagues.

New international guidelines for primary care on managing respiratory problems1

IPCRG publishes Guidelines for the Management of Chronic Respiratory Diseases in Primary Care for GPs/family phsycians and primary care workers including new symptom-based diagnostic tool and guidance for low and middle income countries

Experts from the International Primary Care Respiratory Group (IPCRG) have published new guidance to GPs/family physicians and primary care workers on the prevention, diagnosis and management of respiratory problems commonly seen in patients attending primary care clinics. Welcomed by GINA, GOLD and ARIA international guidelines groups
They are welcomed by the Heads of the three international guidelines groups, GINA, GOLD and ARIA that issue guidance on asthma, chronic obstructive pulmonary disease (COPD) and allergic rhinitis (often known as "hayfever") respectively. Recognises role of primary care
It is estimated that approximately 85% of all patients with asthma or with COPD in the UK2 and in the Netherlands3 are treated by their general practitioner (GP). GPs are well placed to manage such chronic conditions as they tend to have a long-term continuous relationship with their patients4 and, as generalists, also manage their patients' comorbidities5. Therefore, it is important that GPs are helped to keep up-to-date with improvements in the evidence-base for optimal respiratory disease prevention and care. New diagnostic tool
The IPCRG's understanding of primary care practice prompted it to develop new guidance on how to achieve an accurate diagnosis prior to treatment. As Dr Mark Levy says "patients tell us about their symptoms such as breathlessness and cough, and it is our job to correctly identify what is causing these symptoms before selecting the appropriate treatments. Incorrect treatment is by definition under- or over-treatment and can cause false reassurance." Evidence-based
The guidelines, published in the IPCRG and GPIAG journal Primary Care Respiratory Journal, are fully evidence-based. Appropriate for low and middle and high income countries
The guidelines recognise the variation in available resources of money, time, equipment and regulation in different countries and explore what the evidence shows to be essential interventions and what, given improved resources, would be ideal interventions for prevention, diagnosis and management. The guidelines are also available online via Science Direct to increase access.

Dissemination and implementation
The Chair of the IPCRG Guidelines Committee Professor Onno Van Schayck explained that the key role of the IPCRG is now to disseminate the guidelines widely to grass roots GPs and to support their implementation using the evidence about what changes physician behaviour. He said that "it is well known that publishing guidelines alone will not change the actual care provided by physicians6. A large study that investigated the best strategy for implementing guidelines concluded that physician education combined with monitoring behaviour and feedback is also required7. Analysing recent research on how guidelines affect patient outcomes, Dr Ron Tomlins [doi:10.1016/j.pcrj.2005.11.004] also draws attention at a local level to the need for specific patient feedback and at a national level for governments to structure physician incentives for the delivery of evidence-based care.

The IPCRG Education Committee will be working across the world with its IPCRG colleagues, its associate members EFA and Education for Health and also collaborate with Wonca to adapt the guidelines for widespread national distribution and to develop local education programmes, monitoring and feedback. References
1Primary care Respiratory Journal, 2006, Issue 15(1). Available online at

2Royal College of Family Physicians, Office of population censuses and surveys, Department of Health and Social Security. Morbidity statistics from general practice 1981-82. Third national study. Series MB5 no. I London; Her Majesty's Stationary Office.

3Tirimanna PRS, Schayck CP van, Otter JJ den, et al. Prevalence of asthma and COPD in general practice in 1992: Has it changed since 1977? Br J Gen Pract 1996;46:277-81.

4Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: a multidisciplinary review. Brit Med J 2005; 327: 1219-21

5Starfield B, Lemke KW, Bernbardt T, Foley SS, Forrest CB, Weiner JP. Comorbidity: implications for the importance of primary care in 'case' management. Ann Fam Med 2003;1:8-14

6Grimshaw JM, Russel IT. Effects of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 1993;342:1317-22.

7Smeele IJM, Grol RPTM, Schayck CP van, Bosch WJHM van den, Hoogen HJM van den, Muris JWM. Can small group education and peer review improve care for patients with asthma/chronic obstructive pulmonary disease? Quality in Health Care 1999;8:92-8. About the International Primary Care Respiratory Group (IPCRG)
The IPCRG is a charitable company that acts as an international umbrella organisation for national primary care respiratory interest groups. Our aim is to use our international network to undertake research in community settings; to lead the production of evidence-based guidelines appropriate for primary care professionals; and to disseminate these findings. Find out more about the IPCRG at: For further information about the development of these guidelines, please contact:
Prof Dr Onno van Schayck
Scientific co-director Research Institute Caphri University Maastricht, The Netherlands
Tel: +31-43-3882152
Fax: +31-43-3619344

For general information about the IPCRG please contact

IPCRG Secretariat
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