From needs to priorities. Using a Delphi technique to prioritise the IPCRG Research Needs Statement Osman Yusuf Mike Thomas Anders Ostrem Ioanna Tsiligianni

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


145 research needs

Asthma

COPD


Tobacco dependence

Allergic rhinitis

47

26

35

16

21


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


Method

The questions

• 145 questions

• Five disease area

• Score 1 (low) to 5 (top)

Feedback the median score for subsequent round


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


Method

Defining priority

First round

• Clinical importance

• Feasibility

• International relevance

Round 2 Round 3

• Priority for the IPCRG} • Priority

for the IPCRG


Method

Defining consensus

Consensus was definedas 80% agreement

for the priority score of 4 or 5.

Results


Results

Expert panel23 members100% completion

21 countriesAcademicsPractising cliniciansRange of clinical interests

145 questions

62 questions80%


Consensus80% agreementScore of 4 or 5

24 questions90%

7 questions100%

Asthma

47 questions

20 questions80%

9 questions90%

2 questions100%



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%



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%



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%



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%



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


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


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


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

Documents

From needs to priorities. Using a Delphi technique to prioritise the IPCRG Research Needs Statement Osman Yusuf Mike Thomas Anders Ostrem Ioanna Tsiligianni