The IPCRG research needs statement and prioritisation
The IPCRG Research Needs Statement 2010 identified the main questions facing both clinicians and patients in community situations in asthma, allergic rhinitis, chronic obstructive pulmonary disease, tobacco dependence and lower respiratory tract infection. These questions were then prioritised using an e-Delphi process. This prioritisation exercise is now being updated.
The Needs Statement 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.
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
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.
Chronic obstructive pulmonary disease (COPD)
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 comorbidities and what does that mean for screening and treatment?
Prevention of smoking in young people and smoking cessation in adults is crucial to reducing premature mortality, morbidity and improve the 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.