Asthma Management Handbook

Framework

Overall approach

The Australian Asthma Handbook is recognised as the national treatment guidelines for asthma and has been published by the National Asthma Council Australia since 1990.

As experienced guideline developers, we follow 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 use the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument as a benchmark for our guideline development process and reporting.1 We also refer to the NHMRC standards for clinical practice guidelines,2 including the NHMRC system for grading evidence-based recommendations.3

Guiding principles

Multidisciplinary contributor and user involvement

We have a multidisciplinary approach in developing the Australian Asthma Handbook to ensure the advice remains 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 is represented in the multidisciplinary working groups and overarching Guidelines Committee, which is chaired by a general practitioner. The needs of target users from a range of disciplines are canvassed in the initial user survey for each edition.

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 provide advice within the established primary care chronic disease management framework with an holistic approach to treatment and self-management considerations.

Structured and transparent methodology

We use a structured and transparent methodology to formulate the advice. The recommendations are developed using standardised methods, including structured literature review, 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. The most important information (the recommendations) is the most prominent, underpinned by supporting materials at deeper layers. Hyperlinks to cited references and external resources are provided wherever possible.

A modular approach means that the same recommendation, figure, table or more information topic can 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). 2016 NHMRC standards for guidelines. NHMRC, Canberra, 2018. Available from: https://nhmrc.gov.au/about-us/publications/2016-nhmrc-standards-guidelines
  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: https://nhmrc.gov.au/research-policy/guideline-development/resources-guideline-developers