IPCRG research needs statement: answers needed to improve the management of respiratory diseases globally
The IPCRG Research Needs Statement 2010 identifies the main questions facing both clinicians and patients in community situations in: asthma, allergic rhinitis, chronic obstructive pulmonary disease (COPD), tobacco dependence and lower respiratory tract infection (LRTI).
It was developed by over 40 contributors following a consultation process including IPCRG members, other recognised experts and representatives from over 62 countries with a wide range of health and socio-economic systems and resources.
The lead author, Dr Hilary Pinnock comments "The IPCRG hopes that this statement will become the primary document to guide researchers in this field, to support clinicians and patients campaigning for answers and inform funding bodies prioritising research agendas." (Click here for a PDF with slides from Dr Pinnock's presentation at the IPCRG Toronto Conference - opens in new window, 1.5Mb).
This statement sits within the context of the draft World Health Organisation (WHO) research agenda for non-communicable diseases, which not only prioritises chronic respiratory diseases and tobacco control, but also specifically emphasises the core role of primary care in the management of long-term conditions."
The statement highlights two main areas for improvement:
- There is a need for research undertaken within primary care which:
- Recruits patients representative of primary care populations
- Evaluates interventions realistically delivered within primary care
- Draws conclusions that will be meaningful to professionals working within primary care
- International and national guidelines exist but there is little evidence on the best strategies for implementing these recommendations.
The key findings of the IPCRG with regards to: asthma, allergic rhinitis, chronic obstructive pulmonary disease (COPD), lower respiratory tract infection (LRTI) and tobacco dependence include:
- The IPCRG statement builds on The Brussels Declaration that advocates a ten point plan of action to improve evidence-based asthma management, emphasising the inclusion of evidence from real life studies in treatment guidelines.
- Current treatment guidelines are based on trials that do not address the practical issues such as: inadequate inhalation technique, perceived side effects of steroids, patient preference for regular treatment, and the impact on adherence
- Allergic rhinitis:
- Widespread under-diagnosis means that there is still insufficient data about the epidemiology of allergic rhinitis.
- Challenges for the care of people with allergic rhinitis include: raising the expertise of primary care clinicians, testing the best assessment tools, ensuring availability and affordability of suitable self-treatment and prescription medications, and local characterisation of allergens.
- Primary care clinicians have an important role in prevention, identification and management and palliative care of patients with COPD, but practical questions remain about how to deliver this comprehensive agenda in diverse primary care settings.
- COPD is both under-diagnosed and over-diagnosed in primary care so what is the best way to identify and diagnose COPD in primary care? How should the effectiveness of treatments be monitored? How should people with mild or moderate COPD be best managed in different settings by a combination of lifestyle advice, therapeutic treatment and physical activity? What are the most prevalent co morbidities and what does that mean for screening and treatment?
- Tobacco dependence:
- Prevention of smoking in young people and smoking cessation in adults is crucial to reducing premature mortality, morbidity and improve quality of life of those suffering from non-communicable diseases.
- Outstanding questions address: awareness raising, mechanisms for encouraging evidence-based primary care cessation services including identification of smokers, brief advice, psychological and pharmacological support tailored to the needs of different populations and healthcare systems across the world.
- Lower respiratory tract infection:
- Most patients with LTRIs are managed in primary care accounting for an estimated 15% of general practice contacts.
- There is a need for further epidemiological research, and for evidence to guide the diagnosis and treatment of LRTI, including rational and cost-effective strategies to optimise antibiotic prescribing.
H Pinnock et al. The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010. Prim Care Resp J 2010; 19(Suppl 1): S1-S20.
A subsequent study was undertaken by the IPCRG to prioritise these questions.
The IPCRG's Portuguese group undertook a similar Delphi process (link to BMC Family Medicine 2016) to agree the most important questions for the Portuguese context.