Dissemination and implementation of the Australian Asthma Handbook is an ongoing focus of the National Asthma Council Australia. Dissemination of the guidelines includes both physical distribution of the printed Quick Reference Guide and promotion of the online Handbook.
The major sponsor(s) of each version receive bulk copies of the Guide for their representatives to distribute to GPs, practice nurses and pharmacists nationally. The Royal Flying Doctor Service provides a further distribution avenue to reach rural and remote practitioners. Copies are also available directly from the National Asthma Council Australia on request.
Regular promotional activities for the guidelines are directed towards members of colleges and associations of relevant health professions, for example at national conferences, and other stakeholder organisations.
Ongoing dissemination is focussed on the next generation of primary care health professionals. Medical and pharmacy schools across Australia annually receive sufficient printed copies of the Quick Reference Guide for the year level most relevant to asthma education.
Dissemination and implementation of the guidelines are both addressed by the National Asthma Council Australia's long-standing health professional asthma and respiratory education program, Asthma Best Practice for Professionals (formerly known as A-Team workshops). Funded by the Australian Government Department of Health, the program involves peer-led workshops held with Medicare Locals and Primary Healthcare Networks in rural, regional and urban locations around Australia and reaches many thousands of primary care health professionals. The education program content is regularly revised to include the latest recommendations from the Handbook, and participants receive printed copies of the current Quick Reference Guide.
Consideration of the practicality and accessibility of the recommendations was fundamental to the development of the Handbook, as this is a key driver of implementation. For example, all referral advice takes into account access and gives alternatives, all use of devices (e.g. spirometers) gives options for practices without those devices and all medicines not reimbursed by the PBS are explicitly flagged. This is supported by the use of plain language for all recommendations and a clear information hierarchy for the complex online Handbook.
The Handbook includes a wide range of recommendations relevant to primary care health professionals. To facilitate implementation of the guidelines into everyday clinical practice, the core recommendations are summarised as figures in the Diagnosis, Management and Acute Asthma sections. In addition, the Quick Reference Guide highlights the key figures and tables.
Health system priorities
From a broader health system perspective, the key points for implementation are:
- Confirm the diagnosis of asthma before starting treatment
- Before considering stepping up treatment, check symptoms are due to asthma, inhaler technique is correct, and adherence is adequate
- When asthma is stable and well controlled for more than 3 months, consider stepping down treatment
- For every person with asthma, develop an individualised written asthma action plan that is appropriate for their treatment regimen, asthma severity, culture, language, literacy level, and ability to self-manage
- For those who smoke, advise quitting and support them to quit. Advise women not to smoke while pregnant, and support them to quit
- For a pregnant woman with asthma, prescribe preventers, if indicated, just as for other adults, aiming to maintain the best possible asthma control and to avoid asthma flare-ups
- Advise patients that having asthma does not prevent them doing physical activity, including exercise training. Recommend physical training to adults and children with asthma, as part of overall asthma management, for its beneficial effect on quality of life.