Mind the gaps

A total of 300 million people in the world are estimated to suffer from asthma and it is the most common chronic disease among children. Cases are increasing and this prevalence is especially evident with children from urban areas. Asthma is a potentially fatal condition but can be well controlled when medicines are used correctly. Despite this, asthma is still under diagnosed and under treated. Experts suspected that doctors wrongly believed their patients' asthma was well controlled and that parents and children did not have a realistic view of the severity of the condition.

We developed the Mind the Gaps programme of events to challenge specialists in paediatric asthma to review asthma management and control of their child patients. The programme would ask clinicians to consider what was important to patients and parents and to examine how they could improve their practice to meet their patients' needs. The overall aim was to improve outcomes for children.

A severe asthma attack, as reconstructed in the case study film used at the ART Forum

Objectives
• Develop an innovative patient-focused medical education programme that improves awareness of asthma management guidelines
• Target 1,000 leading paediatric asthma experts
• Increase understanding of levels of asthma mismanagement in children
• Improve patient outcomes in children with asthma. 

Tactics
The Room to Breathe Survey:
We developed the Room to Breathe survey, the largest  international survey of parents and children with asthma. More than 2,000 interviews were completed across five countries. Each child interviewed had their asthma measured by validated criteria. The questionnaire was developed with guidance from three international experts in paediatric asthma who made up the scientific committee. They analysed the results and were involved in developing the subsequent medical education programme.

The survey examined the attitudes of parents and children towards asthma and the limitations it imposes on their lives. The Room to Breathe survey identified some important gaps in the management of asthma, namely:
• Asthma was uncontrolled and was considered a mild condition by participating parents and children in contrast to validated criteria
• Nearly two thirds of parents were concerned about steroid treatments
• One in five children felt different from other children and one in 10 had been bullied due to the condition.

Advances in Respiratory Therapeutics (ART) Forum:
An international one-day meeting for respiratory experts was held to present the results of the survey to the clinical community for the first time. In the following discussions, many attendees were surprised by the survey's results, highlighting the work that needs to be done to improve the management of childhood asthma.

We scripted and filmed the story of Joanna, a typical teenage girl with persistent asthma. Details were drawn from the results of the survey and approved by a scientific committee. The film graphically showed how a lack of communication in the treatment of paediatric asthma put Joanna in hospital.   

The audience was invited to consider the evidence portrayed in the film that led to misunderstandings, mismanagement and hospital admission. Poor communication between doctors and disengaged patients was agreed to be a reason for loss of asthma control and poor management. A medical communications expert gave practical advice on how to improve communication between doctors, children and their parents. Key pad voting was used before and after sessions to evaluate how the opinions of the attendees had changed.

As a reflection of its quality, the meeting was awarded six continuing medical education points from the European Accreditation Council for Continuing Medical Education. This is the maximum number of points for a one-day meeting.

The ART Forum was attended by 264 leading clinicians with an interest in asthma from 13 countries.

European Respiratory Society (ERS) Congress - Vienna:
The authors submitted an abstract of the survey to the congress organisers, which was accepted and led to an oral presentation in the scientific programme, which was attended by nearly 300 clinicians.

The results of the survey were also released to the media at the ERS congress at a press briefing, attended by 25 journalists. This provided an opportunity to question two of the clinicians who helped design the survey. In addition, the results were used at a satellite symposium at ERS, attended by an estimated 550 clinicians.

Publication of the Room to Breathe Survey:
The scientific committee of the Room to Breathe survey plans on developing multiple scientific papers based on the results of the survey.

Results and evaluation
So far over 1,000 clinicians have been exposed to the Room to Breathe data. More than nine out of 10 agreed that more could be done to improve the implementation of the asthma management guidelines. 96 per cent of doctors agreed that better communication between healthcare professionals, patients and parents would improve clinical outcomes.

Professor Paul Brand, chair of the scientific committee said: "When we saw the survey results, it was a stop-and-think moment for us and we wanted our colleagues to have the same desire to do more for their patients. The programme developed made the clinical community look at these results and realise that they have a responsibility to reduce asthma burden by controlling patients better and improving their communication skills."

Case study details

Client: Nycomed
Agency: FD Santé
Campaign: Mind the Gaps
Timescale: October 2008 to September 2009