Asthma Management Handbook

Framework

Overall approach

The Australian Asthma Handbook is the seventh edition of Australia's asthma guidelines published by the National Asthma Council Australia.

As experienced guideline developers, we followed current best practice in guideline development methodology, taking into account our target users' needs and expectations, our contributors' capabilities and availability, and our organisation's limited resources.

We used the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument as a benchmark for our guideline development process and reporting.1 We also referred to the NHMRC standard for clinical practice guidelines,2 including the NHMRC system for grading evidence-based recommendations.3

Guiding principles

Multidisciplinary contributor and user involvement

As with previous editions, we adopted a multidisciplinary approach in developing the Australian Asthma Handbook to ensure the advice remained relevant and implementable by the target users.

Effective asthma management involves the whole primary care team, working with the person and also their family or carer where appropriate. Therefore, the whole primary care team was represented in the multidisciplinary working groups and overarching Guidelines Committee, which was chaired by a general practitioner. The needs of target users from a range of disciplines were canvassed in the initial user survey and the final user acceptance testing.

Patient-centred approach

We recognise that each person with asthma has a unique set of medical, psychosocial and cultural factors that may influence their health outcomes. We provided advice within the established primary care chronic disease management framework with an wholistic approach to treatment and self-management considerations.

The patient advocacy organisation Asthma Australia was a key body consulted during the stakeholder review phase. In addition, the asthma and respiratory educator working group members acted as informal patient champions during development, advocating for advice that would be realistic and appropriate for a wide range of people with asthma.

Structured and transparent methodology

We used a structured and transparent methodology to formulate the advice. The recommendations were developed using standardised methods, including systematic review (for five key clinical questions), consideration of selected evidence, adaptation of existing guidance, and consensus based on best-available evidence and clinical experience.

We implemented an icon system throughout the Handbook to indicate the method used to develop each recommendation. Clicking on the icon reveals more detail on the type and scope of evidence considered, where relevant, and links through to the cited references.

Focus on clear and practical advice

Consideration of the practicality and accessibility of the recommendations was fundamental to the development of the Handbook. For example, all referral advice takes into account access and gives alternatives, all use of devices 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 supporting materials.

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 key recommendations are summarised as as practical figures: flow-charts for diagnosis, stepped ziggurats for management and treatment algorithms for acute asthma.

Optimisation for online publication

Publishing the full Australian Asthma Handbook as a purpose-built website rather than a printed document allowed us to exploit the advantages of online publishing, such as providing active cross-references and avoiding unnecessary overlap or repetition. Setting up the layered structure before drafting the Handbook content ensured that the most important information (the recommendations) was the most prominent, underpinned by supporting materials at deeper layers. Hyperlinks to cited references and external resources were provided wherever possible.

A modular approach meant that the same recommendation, figure, table or more information topic could appear consistently on multiple relevant webpages.

References

  1. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. Can Med Assoc J. 2010; 182: E839-E842. Available from: http://www.cmaj.ca/content/182/18/E839.short
  2. National Health and Medical Research Council (NHMRC). Procedures and requirements for meeting the 2011 NHMRC standard for clinical practice guidelines. NHMRC, Canberra, 2011. Available from: http://www.nhmrc.gov.au/guidelines/publications/cp133-and-cp133a
  3. National Health and Medical Research Council (NHMRC). NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. NHMRC, Canberra, 2009. Available from: http://www.nhmrc.gov.au/guidelines/resources-guideline-developers