In My Practice: Asthma in Portugal Jaime Correia de Sousa, MD, PhD Associate Professor, School of Health Sciences, University of Minho, Portugal President-Elect of the International Primary Care Respiratory Group

Conflict of interest disclosure I have no, real or perceived, direct or indirect conflicts of interest that relate to this presentation. I have the following, real or perceived direct or indirect conflicts of interest that relate to this presentation: Affiliation / financial interest Nature of conflict / commercial company name Tobacco-industry and tobacco corporate affiliate related conflict of interest None Grants/research support (to myself, my institution or department): Honoraria or consultation fees: Participation in a company sponsored bureau: Stock shareholder: Spouse/partner: Other support or other potential conflict of interest:

Session Outline My daily work with patients with asthma PHC in Portugal My practice My daily work Asthma in my practice Diagnosis Investigation Treatment Follow up

PHC in Portugal In Portugal PHC teams take care of patients in all age groups. Children, maternal health, family planning, adults, elderly; Prevention, cancer screening, acute and chronic care, home visits. PHC contract is based on basic salary + capitation fee + performance indicators and targets. Under and post graduate teaching, medical and nursing students. There’s a gate-keeping system, though there are a lot of bypasses.

Where I work Matosinhos,  ‎175,478 inhab.

My practice My daily work A group practice: 13,600 patients 8 family physicians 7 practice nurses 5 clinical secretaries. I have 1690 patients; I work 40 h/ week; I have the same list for the last 17 years, some patients for over 30 years; 2nd & 3rd generation 14,8% patients < 14 years age. PHC professionals use a common software; a lot of data and information is shared with hospitals

My practice

Asthma in my practice 190 (11.27%) patients have asthma; 53% female; 118 (7%) have current asthma; Severity of asthma % Intermittent 42.9 Mild persistent 24.0 Moderate persistent 28.6 Severe persistent 4.5 Total 100.0 Level of control of asthma % Controlled 25.1 Partially controlled 46.3 Uncontrolled 24.6 Total 100.0

Prevalence of asthma by age group, Matosinhos, Portugal 12.86 13.13 Cases per 100 population 10.24 9.56 5.00 n=576

My daily work with patients with asthma Diagnosis: Symptoms -> anamnesis -> suspected asthma -> investigation -> acute -> treatment -> investigation Hospital discharge -> suspected or confirmed asthma -> treatment -> follow-up

Investigation: Symptom record sheet Peak Flow Meter Spirometry

My daily work with patients with asthma Treatment: Portuguese National Asthma Guidelines produced by the Directorate-General of Health and the Medical Association Choice of inhalers – GRESP inhaler devices desktop helpers Most of the drugs and combinations are available GP’s can prescribe any of the drugs Patients pay 31% of the cost. Prices are regulated by INFARMED, the Portuguese National Agency of Medicines and Health Products

Portuguese Asthma Guideline from 2011 – Updated in 2012 The 2016 Update is being reviewed for publication

Inhaler devices desktop helper

Inhaler devices desktop helper

My daily work with patients with asthma Follow-up: Record Keeping CARAT & CARAT Kids ACT Observation of inhaler technique

CG/2007

My daily work with patients with asthma Loss of control: Difficult to manage asthma algorithm Guidelines for the treatment of exacerbations Referral ACOS differential diagnosis algorithm

ACOS – Asthma COPD Overlap Syndrome

Developing team work in respiratory diseases Similar to the model used in diabetes, child or maternal health in PHC Defining tasks and roles Providing continuity of care Being accessible for exacerbations / loss of control Using a common information system Which are the challenges? Agreeing on performance indicators Defining the model Training

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