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From needs to priorities. Using a Delphi technique to prioritise the IPCRG Research Needs Statement
• Osman Yusuf• Mike Thomas• Anders Ostrem• Ioanna Tsiligianni• Björn Ställberg• Miguel Roman-Rodriguez• Sian Williams• Hilary Pinnock
The Research Needs Statement 2010
http://www.theipcrg.org
http://www.thepcrj.org/index.php
IPCRG Research Needs Statement 2010
A key message
There is a need for research:
• undertaken within primary care
• recruiting populations representative of primary care patients
• evaluating interventions realistically delivered within primary care
• drawing conclusions meaningful to professionals working within primary care
PreventionDiagnosisManagementSelf-managementOrganisation of care
Asthma
COPD
Respiratoryinfections
Tobacco dependence
Allergic rhinitis
47
26
35
16
21
IPCRG Research Needs Statement 2010
145 research needs
Asthma
COPD
Respiratoryinfections
Tobacco dependence
Allergic rhinitis
47
26
35
16
21
IPCRG Research Needs Statement 2010
145 research needs
.. but which are priorities?
The e-Delphi
• Hilary Pinnock, Edinburgh, UK• Osman Yusuf, Islamabad, Pakistan• Mike Thomas, Aberdeen, UK• Anders Ostrem, Oslo, Norway• Ioanna Tsiligianni, Heraklion, Crete • Björn Ställberg, Uppsala, Sweden• Miguel Roman-Rodriguez, Spain• Sian Williams, IPCRG
AimTo use an e-Delphi consensus process
to identify the priority research questions in each disease domain
of the IPCRG Research Needs Statement
Method
IPCRG RNS e- Delphi 2011
Method
An expert panel who contribute ideas
Invited 63 participants
• Authors and other contributors to the RNS
• IPCRG research sub-committee and network
• Leads of member and associate member countries
• IPCRG education sub-committee and panel
IPCRG RNS e- Delphi 2011
Method
The questions
• 145 questions
• Five disease area
• Score 1 (low) to 5 (top)
Feedback the median score for subsequent round
IPCRG RNS e- Delphi 2011
Method
Priority for IPCRG Your score Median score
1 = low priority 1 = low priority 1 = low priority
5 = high priority 5 = high priority 5 = high priority
Asthma
2.1. Prevention
What are the important environmental risk factors (including indoor bio-mass fuel smoke, cigarette smoking and environmental pollution, aeroallergens, dietary and lifestyle factors) in different countries and what preventative measures can effectively reduce the prevalence and severity of asthma?
5 4
Are primary care physicians aware of the allergens and respiratory irritants in their area? Are they aware of the preventive measures against such asthma triggers?
4 3
What strategies will improve detection and prevention of occupational asthma in primary care? 3 3Priority for IPCRG
2.2. Diagnosis 1 = low 5 = high Your score Median score
How can asthma be diagnosed earlier in primary care? 5 5What is the role of symptom-based tools for diagnosing asthma in primary care? 3 4What are the reliability, validity and feasibility of different diagnostic tools such as spirometry, peak-flow measurement, challenge tests, exhaled nitric oxide and allergy testing in the diagnosis of asthma in primary care
4 4
What are the cut-off values for abnormal spirometry (lower limit of normal), reversibility tests and diurnal variation of peak-flow measurement across a broad range of age groups and ethnicity
4 3
How can rural and remote areas or developing countries diagnose and manage asthma with limited or no availability of diagnostic tests?
5 4
Round 2 priority scores
IPCRG RNS e- Delphi 2011
Method
Defining priority
First round
• Clinical importance
• Feasibility
• International relevance
Round 2 Round 3
• Priority for the IPCRG} • Priority
for the IPCRG
IPCRG RNS e- Delphi 201110
Method
Defining consensus
Consensus was definedas 80% agreement
for the priority score of 4 or 5.
Results
IPCRG RNS e- Delphi 2011
Results
Expert panel23 members100% completion
21 countriesAcademicsPractising cliniciansRange of clinical interests
145 questions
62 questions80%
IPCRG RNS e- Delphi 2011
Consensus80% agreementScore of 4 or 5
24 questions90%
7 questions100%
Asthma
47 questions
20 questions80%
9 questions90%
2 questions100%
IPCRG RNS e- Delphi 2011
IPCRG RNS e- Delphi 2011
What simple tools enable assessment of asthma control, and is their use acceptable and feasible in primary care?
100%
How can guided self-management be implemented in real life primary care practice?
96% How can asthma be diagnosed earlier in primary care?
How and when should regular medication be stepped down or stopped?
Asthma
Asthma
80% 20 questions
Allergic rhinitis
26 questions
9 questions80%
3 questions90%
2 questions100%
IPCRG RNS e- Delphi 2011
IPCRG RNS e- Delphi 2011
What (combinations of) management strategies for treating rhinitis improve asthma control, and/or improve quality of life?
100%
What tools (e.g. validated, symptom-based questionnaires for rhinitis or screening for atopy) could help the primary care clinician differentiate between allergic rhinitis....and other similar conditions?.
91% What questions for use in primary care practice will determine rhinitis control, and identify those at risk of worsening symptoms and/or onset of co-morbid asthma?
Rhinitis
Allergic rhinitis
80% 9 questions
35 questions
COPD
19 questions80%
6 questions90%
2 questions100%
IPCRG RNS e- Delphi 2011
IPCRG RNS e- Delphi 2011
Can the use of a simple validated questionnaire improve the accurate identification of COPD in different of countries (including those without access to spirometry)?
100%
When a primary care approach to the diagnosis of COPD is applied, what is the diagnostic yield compared to currently accepted diagnostic criteria?
Which measurements ....are feasible, and provide useful information for routine monitoring ....in primary care worldwide
96% What is the best way to identify and diagnose COPD in primary care? Does this incorporate history, age, symptoms and spirometry?
COPD80% 19 questions
COPD
16 questions
Smoking
9 questions80%
2 questions90%
IPCRG RNS e- Delphi 2011
IPCRG RNS e- Delphi 2011
Smoking80% 9 questions
Tobacco dependence
How can brief advice be used more effectively to increase motivation to quit, and what elements are most efficient for a busy primary care practitioner?
96%
91%
87%
What questions provide the most sensitive and specific assessment of tobacco dependence and motivation to quit....?
How can primary care clinicians in different countries be made more aware of strategies to prevent smoking in young people / pregnancy?
24 questions
Respiratory infections
5 questions80%
5 questions90%
1 question100%
IPCRG RNS e- Delphi 2011
IPCRG RNS e- Delphi 2011
96% How can primary care clinicians differentiate between serious and self-limiting LRTIs?
Should management strategies for LRTI be different in subgroups with co-morbidities, in smokers, in the elderly, children, or pregnancy?
Which subgroups of patients with LTRIs need antibiotic treatment?
Infections80% 5 questions
Respiratoryinfections
How can primary care clinicians reliably identify patients who would benefit from antibiotic therapy? What diagnostic criteria are used in deciding on antibiotic treatment ...?
100%
Over-arching themes
IPCRG RNS e- Delphi 2011
Themes
46% related to diagnosis and assessment23% identified the need for ‘a primary care approach’16% specified the need for validated questions
19% related to management strategies
Of the prioritised questions
Conclusion
IPCRG RNS e- Delphi 201110
Conclusions
The five diseases all contributed priorities for the IPCRG
• Diagnosis and assessment
• Questionnaires and other ‘simple tools’
• Practical management/treatment strategies
• Implementing self-management
Overarching priority themes
Specific priority questions in the five diseases
Thanks!• The expert panel
• The research team for advice and support
• Katie Searles for the administration
From needs to priorities. Using a Delphi technique to prioritise the IPCRG Research Needs Statement
• Osman Yusuf• Mike Thomas• Anders Ostrem• Ioanna Tsiligianni• Björn Ställberg• Miguel Roman-Rodriguez• Sian Williams• Hilary Pinnock