Annual report from WONCA Europe Special Interest Groups 2014

Annual report from WONCA Europe Special Interest Groups 2014
ESPCG: European Society for Primary Care Gastroenterology
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Composition Executive:
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Achievements/Projects:
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Launch of new website
E-learning module for IBS translated into several languages (French, German, Spanish and Italian)
A survey of gastro practice among European GPs.
Launch of EuroDigest Publication
Meetings:
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Prof Lars Agréus, Stockholm, Sweden, chairman;
Dr Martin Rasmussen, Finland, secretary general;
Dr Lina Forssell, Sweden, treasurer;
Prof Niek de Wit, Utrecht, the Netherlands, educational officer;
Prof dr. Pali Hungin, Durham, United Kingdom, research officer.
Involvement of ESPCG in WONCA conferences; sadly this year we do not have a session in Lisbon, but
looking forward to Istanbul 2015 in the hope we can get a session there
Executive board and research meeting in Crete March 2013 and Venice March 2014. Apart from the
meeting a half day research seminar was held with colleagues from Greek (Crete) and Italian (Venice)
Gastro Groups to discuss ongoing research projects.
For the United European Gastroenterology Week (UEGW) meeting in October 2013 in Berlin, several
committee member attended the sessions
Collaborations:
ESPCG is an associate Member of the United European Gastroenterology (UEG).
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Future plans:
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Launch of EuroDigest at UEG Week in October 2014, Vienna
Future Stars awards?
Endorsement of Parma Meeting?
ESPCG Books?
ESPCG Research programme?
Sponsor policy;
In recent years the ESPCG has obtained independent funding, through the United European Gastroenterology
(UEG). However we are now seeking funding from pharmaceutical companies. Almirall and Danone are
currently supporting us, with more companies in the pipeline.
Affiliations:
ESPCG is a member of UEG and a member of Wonca Europe.
PCDE
Everywhere in the world, numbers of people with diabetes and chronic diseases as a whole are increasing
leading to an epidemic, worse than any contagious disease ever could have caused. Besides, thanks to
technological developments and better health care conditions people live longer. Both topics combined raise
an important issue of numerous people living with diabetes in an aging population, characterized by multi
morbidity and lower quality of life. This alters the healthcare needs of people living in different communities.
Primary Care Diabetes Europe (PCDE) has been established to support all people with diabetes, their relatives,
informal carers and professional primary health care providers to enhance the quality of the care to all of them
as well as the quality of their lives.
MISSION PCDE
Primary Care Diabetes Europe (PCDE) exists to provide a focal point for primary care clinicians and their
patients. Its purpose is to promote high standards of care for people living with diabetes throughout Europe.
Emphasis is placed on incorporating evidence based medicine into daily practice as well as promoting diabetes
education and research in primary care.
AIMS PCDE
PCDE aims to empower and maintain projects in the following domains:
publication of a scientific Journal focussing on all aspects of Primary Diabetes Care
scientific research in the field of Primary Diabetes Care
organising CME/CPD activities for Primary Health Care professionals such as conferences, courses, either
stand alone, in conjunction with other groups or incorporated within other major congress events
maintaining an informative website for all members as well as a broader audience
managing an active network of primary care physicians across Europe, coordinating the care for
individuals living with diabetes
health care leadership through governance
COMPOSITION EXECUTIVE
Executive board:
Chairman : Prof. Johan Wens (BE)
Hon. Secr. Vice Chair : Assoc.Prof.Dr. Xavier Cos (ES)
Exec.Board member responsible for Research Assoc. : Assoc.Prof.Dr. Pinar Topsever (TR)
Treasurer : Mrs. Guusje Neijens (NL)
Working Committee:
Liaison Officer : Dr. Martin Hadley Brown (UK)
Liaison Officer and Chairman of PCDE’s
EASD “Study group Primary Care Research in diabetology” : Assoc.Prof.Dr. Pinar Topsever (TR)
Liaison Officer : Dr. Luc Martinez (FR)
Liaison Officer : Dr. Imre Rurik (HU)
Candidate Liaison Officer : Dr. Gerardo Medea (IT)
Candidate Liaison Officer : Dr. Axel Riefflin (GE)
ACHIEVEMENTS / PROJECTS
PCDE has hosted 13 International Conferences, in the beginning mainly as stand-alone meetings. In more
recent years the conferences were official EASD satellites, thanks to the joined Study Group on Primary Care
Research. The last two conferences were successful international stand alone scientific meetings.
1997 Lisbon
1999 Istanbul
2001 Brussels
2002 Stockholm
2003 Paris
2004 Munich - related to EASD
2006 Athens - related to EASD
2008 Amsterdam - related to EASD
2009 Istanbul - related to WONCA
2010 Istanbul - together with AHEAD
2011 Istanbul – together with EPCCS
and AHEAD
2012 Barcelona – PCDE stand alone conference
2014 Barcelona – PCDE stand alone conference
HEALTH CARE GOVERNANCE
PCDE impacts on European policy level in their consultancy position at different national and international
organisations. Since 2010, the European Coalition for Diabetes (ECD) was established together with the
Federation of European Nurses in Diabetes (FEND), the International Diabetes Federation (IDF) and EURADIA,
the research coordinating organisation of the European Association for the Study of Diabetes (EASD). ECD now
is in constant communication with different members of the European Parliament and various partners in the
European Commission in charge of all aspects of health care governance and research.
On 14 March 2012, the European Parliament adopted the Resolution on addressing the EU diabetes epidemic,
driven by the cross-party and cross-national EU Diabetes Working Group (EUDWG), with the strong support of
other fellow MEPs. The European Coalition for Diabetes (ECD) warmly welcomed this crucial Resolution as a
great achievement marking a significant step forward towards improved diabetes prevention, diagnosis,
management, education and research, for the better health and quality of life of all European citizens living
with this condition.
PCDE is also a member of the “European Forum for Primary Care” which was established in 2005 aiming to
improve the health of the population of Europe and equity in health care delivery by strengthening Primary
Care.
PCDE supports, as an important exemplary project, the Turkish “Diabetes 2020: Vision and Targets”
project. It aims to develop national vision and targets for Turkey, as well as strategies to facilitate them.
The project is coordinated by the Turkish Diabetes Foundation, carried out under auspices of the Turkish
Ministry of Health, and supported by WHO (European Region), IDF Europe, and PCDE.
Research Projects
EASD PCD Study Group
PCDE promoted the creation of a Primary Care Research Group within EASD which was accepted by EASD in
2007. The research objectives of the EASD “Primary Care Diabetes Study Group” are:
To encourage high quality research into clinical, psychological and organisational aspects of
diabetes in primary care
To build a European network of primary care researchers, with wide interests on diabetes
To share research findings
Areas of interest
epidemiological studies: incidence and prevalence in different European countries and different
methodological aspects to calculate these
treatment outcomes and evaluations of new treatment options
adherence to treatment plans
prevention of macro- and micro-vascular complications
screening and early detection of diabetes and its complications
expectations and perspectives of people living with diabetes, their families and their health
professionals
quality of life for individuals with diabetes
social inequities in minority groups suffering from diabetes
influences of the different European health care systems on health outcomes
effectiveness and cost effectiveness of different models of health care delivery on diabetes health
outcomes
The EASD PCD Study Group –according to its regulations- is holding annual business meetings during the EASD
meetings with its active members. The regulations have been updated according to EASD recommendations in
2012 and elections for steering group members have taken place in 2013. The EASD PCD study group has
developed the study protocol and conducted the pilot of the EUCCLID study with PCDE funding (see below
under “Previous research activities”) which resulted in 2 publications.
CKD Study
Now the study group has initiated an international multi-center study on the prevalence of CKD in type 2
diabetic persons in primary care in 8 different European countries.
On-going and future research activities
With public funding:
o Development of 13 General Practice Guidelines for the management of the most common
diseases and conditions in Primary Health Care in Greece.
This project is an initiative with the aim to develop 13 Guidelines in General Practice and Nursing regarding the
management of the most common chronic diseases through the application of a specific methodology, which
has been tested and developed by the Department of Social and Family Medicine of the University of Crete in a
previous INTERREG project.
o “MANAGE CARE”: Active Ageing with Type 2 Diabetes as Model for the Development and
Implementation of Innovative Chronic Care Management in Europe.
This project aims to prevent costly complications and frailty in elderly with type 2 diabetes, enabling them to
live independent, healthy and active lives as long as possible. This will be achieved by driving innovation and
change in the current treatment approach, shifting from diabetes management (disease-specific care
trajectory) to chronic care management (nondisease focused model). A roadmap for implementation of the
model will be developed, providing also guidelines for development of chronic care models in a broader
context.
o EPREDICE: Early Prevention of Diabetes Complications in Europe
A total of 31 centres in Europe and one in Australia (15 of them recruiting patients) are participating in this
clinical trial that has received public economical support by the 7th Framework Programme. This is a long term
(3-5 years), multi-centre, randomised, partially double blinded, controlled (four parallel groups), phase IIIb,
clinical trial with prospective blind outcome evaluation. The main objective is to assess the effect of treatment
with sitagliptin, metformin or the combination of sitagliptin with metformin, plus lifestyle intervention (diet
and physical activity), compared to lifestyle intervention alone, for at least 3 years, and up to 5 years, on
different microvascular parameters (retinal, renal and neurological), as defined by the primary and secondary
endpoints, in adults with non-diabetic hyperglycaemia (IGT, IFG or IFG plus IGT). The principal investigator of
this project is Prof. Jaakko Tuomilehto, also Editor in chief of the PCDE journal (Primary Care Diabetes).
With other funding:
Dawn2 is the largest study of its kind, conducted across 17 countries and 4 continents, into the psychosocial
aspects of management of diabetes. For the first time ever, family members were surveyed – along with people
with diabetes, nurses, dieticians, general practitioners and specialists – to find new ways of reducing the
burden of the condition. “The DAWN2™ study confirms that the physical, financial and emotional burden of
diabetes across cultures and countries is carried by the entire family, not just by the person with diabetes”,
says Professor Mark Peyrot, principal investigator and chair of the international scientific committee
overseeing the DAWN2™ study.
The initial results show that:
63% of family members are anxious about the possibility that the person they live with will develop serious
complications from the condition¹
66% of family members of insulin-treated people with diabetes fear that their loved one will become
hypoglycaemic during the night¹
34% of family members report a negative financial impact on themselves due to the diabetes of their loved
one¹
20% of family members experience that their loved one is being discriminated against because of diabetes
and that the community they live in is intolerant of diabetes¹
35% of people with diabetes report their family argues with them about how they manage their diabetes2
75% of family members have not attended an education programme about diabetes1, despite at least 70%
of diabetes healthcare professionals believe that involvement of family members is a vital part of good
diabetes care3.
The DAWN2™ study brings new and important scientific data about the hidden burden of the diabetes
pandemic on the families of people with diabetes and the gaps in current healthcare systems. The societal
implications of these findings are significant and DAWN2™ results should motivate and compel decision
makers, healthcare providers and patient organizations to act in unity to improve education and support for
both people with diabetes and their loved ones.
Previous research activities
MOTIVATE
This project aims to improve the care of persons with type 2 diabetes mellitus (T2DM) by understanding the
similarities and differences in perceptions of primary care clinicians and patients regarding treatments for
T2DM.
The objectives are to understand:
how patients and clinicians perceive the need for treatments that manage challenges beyond
hyperglycaemia
how clinicians and patients perceive meaningful weight loss
how clinicians and patients perceive weight management as a motivator
EUCCLID
Thanks to the research branch of the association, under chairmanship of Prof. Guy Rutten, the EUCCLID project
was designed and developed as a first achievement of this collaborative research working group. In 2009 the
results of the successful pilot of this study were published within our Journal.
Ref.: Gorter KJ, Wens J, Khunti K, Claramunt XC, Topsever P, Drivsholm T, Jenum AK, Berkhout C, Khalangot M,
Goldfracht M, Rurik I, Lionis C, Rutten GE. The European EUCCLID pilot study on care and complications in an
unselected sample of people with type 2 diabetes in primary care. Prim Care Diabetes. 2010 Apr;4(1):17-23.
The ADDITION study is an Anglo-Danish-Dutch Study in General Practice of Intensive Treatment and
Complication Prevention in Type 2
Diabetic Patients Identified by Screening. Results were presented during EASD 2010 and ADA 2011. It was
a pragmatic and relevant intervention study to everyday general practice and it demonstrated that primarycare-based stepwise screening for type 2 diabetes is feasible and identifies patients with substantial levels of
cardiovascular risk that is potentially modifiable.
Ref.: Sandbaek A, Griffin SJ, Rutten G, Davies M, Stolk R, Khunti K, Borch-Johnsen K, Wareham NJ, Lauritzen T.
Stepwise screening for diabetes identifies people with high but modifiable coronary heart disease risk. The
ADDITION study. Diabetologia.2008;51(7):1127-1134.
Ref.:Griffin SJ, Borch-Johnsen K, Davies MJ, Khunti K, Rutten G, Sandbæk A, Sharp SJ, Simmons RK, van den
Donk M, Wareham NJ, Lauritzen T. Effect of early intensive multifactorial therapy on 5-year cardiovascular
outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised
trial. Lancet, 2011;378(9786):156 – 167.
The SWEET project, under the auspices of Professor Thomas Danne, aims to contribute to reducing the burden
of diabetes and related costs in Europe by addressing diabetes in children and adolescents. More specifically,
the project will aim to improve quality of life outcomes for children with diabetes and their carers, by means of
establishing a network of centres of reference for paediatric and adolescent diabetes services. PCDE is proud to
be an associated partner in this project.
More information on SWEET at :
http://sweet-project.eu/html/en/index_html
CALLIOPE is a Thematic Network with a focus on cross-border e-Health Interoperability. It has been initiated by
17 health authorities and 11 organisations representing groups of physicians, community pharmacists, patients,
industry and health insurers and is supported by the European Commission under the ICT PSP programme.
More information on CALLIOPE : http://www.ehtel.org/activities/eufunded-projects/calliope-call-forinteroperability
The IMAGE project (Development and Implementation of a European Guideline and Training Standards for
Diabetes Prevention), led by Dr Peter Schwarz, is set to improve the management and reduce the impact of
type 2 diabetes across Europe. Effective and immediate primary prevention is essential to lower the burden of
type 2 diabetes within the European Union. The 3 year IMAGE project will help to address this
through the development of:
European practice-oriented guidelines for the primary prevention of type 2 diabetes
A European curriculum for the training of prevention managers
European standards for quality control in the assessment, monitoring and quality reporting of type 2
diabetes prevention
A European e-health training portal
More information on IMAGE : http://www.image-project.eu/
The DIAMAP project, of which the mission is to undertake a wide survey of the current European diabetes
research landscape, from which expert opinion can identify gaps and highlight strengths, aims to guide a Road
Map strategy for diabetes research in Europe.
The objectives of this project are:
1. Survey of research activities and funding for diabetes research, both public and private, at regional, national
and European level
2. Creation of diabetes research database from survey of European and limited worldwide data: intended to be
sustained by EURADIA after initial capital from Commission
3. Identification of gaps, strengths and weaknesses and opportunities in diabetes research in Europe by expert
analysis
4. Development of final Road Map report by an overarching Expert Advisory Board (EAB) to outline strategy for
diabetes research in Europe, taking into account different scenarios, including the Innovative Medicines
Initiative.
PCDE was represented in the Horizontal issues group aiming to build bridges between all different subgroups of
the Diamap project as there are: genetics/epidemiology, islets, pathophysiology /metabolism/ integrative
physiology, micro-vascular complications and macro-vascular complications.
More information on DIAMAP at http://www.diamap.eu/
Starting from the DIAMAP project, Euradia (i.e. the alliance for Diabetes Research) initiated the compiling of a
European Platform for Clinical research in Europe, is which PCDE is represented and will bring in the voice of
Primary Care within European diabetes research.
The DE-PLAN project, led by the University of Helsinki, aims to develop and test models of efficient
identification and intervention of individuals at high risk of type 2 diabetes in the community. It conducts a
lifestyle modification intervention in people at high risk for T2D. Furthermore, it tests the feasibility and cost
effectiveness of the translation of the current research evidence about preventive intervention program into
clinical settings within existing health care systems in 17 European countries.
More information:
http://www.ktl.fi/portal/english/research_people_programs/health_promotion_and_chronic_disease_prev
ention/projects/eu_project_de-plan/
Other research activities
PCDE is also interested in collaborating on other research initiatives and with different research partners As
such PCDE facilitated a Cochrane systematic literature review on Interventions for improving adherence to
treatment recommendations in people with type 2 diabetes mellitus…
Ref: Vermeire E, Wens J, Van Royen P, Hearnshaw H. Interventions for improving adherence treatment
recommendations in people with type 2 diabetes mellitus [Systematic Review]. Cochrane Database Syst Rev.
2005 Apr 18;(2):CD003638
…as well as the OBO project (Obstacles and Outcomes on Living with Diabetes),
Ref. Vermeire E, Hearnshaw H, Rätsep A, Levasseur G, Petek D, Van Dam H, Van der Horst F, Vinter-Repalust N,
Wens J, Dale J, Van Royen P. Obstacles to adherence in living with type 2 diabetes. An international qualitative
study using meta-ethnography (EUROBSTACLE). Primary Care Diabetes. 2006;1:15-23.
COMMUNICATION
Primary Care Diabetes Journal
Primary Care Diabetes is the official journal of PCDE, published by Elsevier Publishing. Since June 2010 editorin-chief is Prof. Jaakko Tuomilehto who is assisted by an international editorial board. The journal publishes
original clinical research articles and clinical practice information for primary health care professionals in the
form of original research articles, brief reports, reviews, editorials, opinions, and case histories. The Journal also
publishes news and articles concerning the policies and activities of PCDE and reflects the society's aim of
improving the quality of care for people with diabetes mellitus within the primary care setting.
Primary Care Diabetes Journal is now indexed in PsycInfo, MedLine, Scopus and Thomson Reuters expanded
Science Citation Index.Thomson Reuters 2013 reports considered 2012 impact factor of 1.609. Diabetes
Knowledge Resource Center Since 2011 PCDE together with Elsevier have launched a new educational tool the
Knowledge Resource Center. Eugene Hughes, past chairman of PCDE is its guest editor. In this Resource Centre
offers a continuously expanded selection of peer-reviewed journal articles related to type 2 diabetes, offering
insights from the latest state-of-the-art research on many aspects and complications of the disorder, as well as
therapy-oriented contributions and general overviews. Also, you will find an online tool with a selection of
Netter images with which you can compose your own Netter poster, as well as educational videos and clinical
monographs.
Online Resources:
• Primary Care Diabetes Journal: http://www.primary-care-diabetes.com/
The online manuscript submission site for the journal is live at: http://ees.elsevier.com/pcd/
• Knowledge Resource Center*: http://www.pcd-glucose-homeostasis.com/
Associate Editor: dr. Eugene Hughes
Website (www.pcdeurope.org)
The website is restructured in April 2013 and updated regularly with the latest news and achievements.
10.2. Affiliations
A particularly close working relationship has already been established with IDF, WONCA, FEND and EASD,
EURADIA as well as other EASD study groups such as Diabetes Education Study Group (DESG) and Cardio
Vascular study group. In 2010 PCDE was strongly involved in the annual DESG meeting, introducing the
concepts of ‘Primary Care’ and stressing its importance and assets for diabetes education as a whole. PCDE
aims to consolidate these affiliations in the future. In addition, there are also close contacts with WHO, WONCA
networks such as EGPRN and EQUIP, and WONCA Special Interest Groups such as the European Primary Care
Cardiovascular Society (EPCCS) as well as other national and international organisations.
Individual members of the Executive Committee have direct links with most of the major diabetes
organisations at a European and even Global level and contribute actively to their respective regular
conferences.
2013 SUPPORTING MEMBERS
PCDE highly values the contribution of all partners who supported all above mentioned PCDE activities with
unconditional grants in 2012-2013.
PCDE is reliant upon sponsorship and would not be able to carry out our important work without it. We would
therefore like to thank our supporting members who make it all possible. Gold Supporting Members 2013.
Astra-Zeneca / Bristoll Myers Squibb Alliance
Elly Lilly and Company
GRIN annual report May 2014
The General Practice Research in Infections Network (GRIN) is a network of researchers with an interest and
track record in infectious diseases. It was founded in 1999 as The General Practice Respiratory Infections
Network and change its name to the current one in 2012. It is independent of the pharmaceutical industry. It
has no structural funding and consist of individual researchers who are active in the field of infectious diseases
and antibiotic use in primary care. Currently we have around 60 researchers from all over the Europe, but also
from Asia, Australia and United States, who are active within GRIN.
Aims
1.
To exchange and discuss new insights in infectious diseases and antibiotic use in primary care
2.
To present research results to colleagues, medical professionals and patients
3.
To stimulate and support new projects on infectious diseases and antibiotic use
4.
To advise authorities and colleagues on the management of infectious diseases
Benefits/major achievements to GP/FM
1.
Since its start it has stimulated and supported research activities
2.
GRIN has been a main basic structure for several major EU funded studies, among which GRACE,
CHAMP, RAPIDD-ID, R-GNOSIS and most recently, SATURN, AIDA and PREPARE.
3.
Members of GRIN have participated in the writing of both national and international guidelines on the
management of respiratory infections
4.
Three members of GRIN are advisers on antibiotic use in outpatients for the European Centre for
Disease Control and one on influenza for European Scientific Network on Influenza.
Membership structure
Anyone who is active in research in the field of infectious disease and antibiotic use in primary care can
participate in GRIN. We have no formal membership.
Meeting structure
GRIN meets once a year on the first Friday and Saturday of October. The 2013 meeting took place in Nice,
France and for 2014 is planned at Antwerp, Belgium,. In addition many members meet during the WONCAEurope congress where presentations are held and preferably special symposia are organised. We also aim to
present on other international congresses such as NAPCRG, ECCMID and ERS meetings. From 2011 to 2015 our
meetings are/will be supported by a funding from the European Science Foundation (ESF).
Presentations and publications
The 2013 WONCA symposium took place in Prague, Czech Republic and 2014 one is planned at Lisbon,
Portugal. In 2013 GRIN members also presented a symposium on the results of the EU project called GRACE at
the ECCMID in Berlin. In addition there were several presentations on joint projects at the 2013 NAPCRG
congress in Ottawa.
In 2013-14 results on collaborative projects were published in among other journals the Lancet Infectious
Diseases, BMJ, Lancet, PlosOne and European Respiratory Journal.
1: Hamoen M, Broekhuizen BD, Little P, Melbye H, Coenen S, Goossens H, Butler CC, Francis NA, Verheij TJ;
GRACE clinical study group. Medication use in European primary care patients with lower respiratory tract
infection: an observational study. Br J Gen Pract. 2014 Feb;64(619):e81-91. doi: 10.3399/bjgp14X677130.
2: Moore M, Stuart B, Coenen S, Butler CC, Goossens H, Verheij TJ, Little P; GRACE consortium. Amoxicillin for
acute lower respiratory tract infection in primary care: subgroup analysis of potential high-risk groups. Br J Gen
Pract. 2014 Feb;64(619):e75-80. doi: 10.3399/bjgp14X677121. Erratum in: Br J Gen Pract. 2014
Mar;64(620):126.
3: Yardley L, Douglas E, Anthierens S, Tonkin-Crine S, O'Reilly G, Stuart B, Geraghty AW, Arden-Close E, van der
Velden AW, Goosens H, Verheij TJ, Butler CC, Francis NA, Little P; GRACE consortium. Evaluation of a webbased intervention to reduce antibiotic prescribing for LRTI in six European countries: quantitative process
analysis of the GRACE/INTRO randomised controlled trial. Implement Sci. 2013 Nov 15;8:134. doi:
10.1186/1748-5908-8-134.
4: Coenen S, Francis N, Kelly M, Hood K, Nuttall J, Little P, Verheij TJ, Melbye H, Goossens H, Butler CC; GRACE
Project Group. Are patient views about antibiotics related to clinician perceptions, management and outcome?
A multi-country study in outpatients with acute cough. PLoS One. 2013 Oct 23;8(10):e76691. doi:
10.1371/journal.pone.0076691. eCollection 2013.
5: Brookes-Howell L, Wood F, Verheij T, Prout H, Cooper L, Hood K, Melbye H, Torres A, Godycki-Cwirko M,
Fernandez-Vandellos P, Ystgaard MF, Falk Taksdal T, Krawczyk J, Butler CC. Trust, openness and continuity of
care influence acceptance of antibiotics for children with respiratory tract infections: a four country qualitative
study. Fam Pract. 2014 Feb;31(1):102-10. doi: 10.1093/fampra/cmt052. Epub 2013 Oct 28.
6: Mills TC, Rautanen A, Elliott KS, Parks T, Naranbhai V, Ieven MM, Butler CC, Little P, Verheij T, Garrard CS,
Hinds C, Goossens H, Chapman S, Hill AV. IFITM3 and susceptibility to respiratory viral infections in the
community. J Infect Dis. 2014 Apr 1;209(7):1028-31. doi: 10.1093/infdis/jit468. Epub 2013 Aug 30.
7: Little P, Stuart B, Francis N, Douglas E, Tonkin-Crine S, Anthierens S, Cals JW, Melbye H, Santer M, Moore M,
Coenen S, Butler C, Hood K, Kelly M, Godycki-Cwirko M, Mierzecki A, Torres A, Llor C, Davies M, Mullee M,
O'Reilly G, van der Velden A, Geraghty AW, Goossens H, Verheij T, Yardley L; GRACE consortium. Effects of
internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational,
cluster, randomised, factorial, controlled trial. Lancet. 2013 Oct 5;382(9899):1175-82. doi: 10.1016/S01406736(13)60994-0. Epub 2013 Jul 31.
8: van Vugt SF, Broekhuizen BD, Lammens C, Zuithoff NP, de Jong PA, Coenen S, Ieven M, Butler CC, Goossens
H, Little P, Verheij TJ; GRACE consortium. Use of serum C reactive protein and procalcitonin concentrations in
addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough:
diagnostic study. BMJ. 2013 Apr 30;346:f2450. doi: 10.1136/bmj.f2450.
9: van Vugt SF, Verheij TJ, de Jong PA, Butler CC, Hood K, Coenen S, Goossens H, Little P, Broekhuizen BD;
GRACE Project Group. Diagnosing pneumonia in patients with acute cough: clinical judgment compared to
chest radiography. Eur Respir J. 2013 Oct;42(4):1076-82. doi: 10.1183/09031936.00111012. Epub 2013 Jan 24.
10: Little P, Stuart B, Moore M, Coenen S, Butler CC, Godycki-Cwirko M, Mierzecki A, Chlabicz S, Torres A,
Almirall J, Davies M, Schaberg T, Mölstad S, Blasi F, De Sutter A, Kersnik J, Hupkova H, Touboul P, Hood K,
Mullee M, O'Reilly G, Brugman C, Goossens H, Verheij T; GRACE consortium. Amoxicillin for acute lowerrespiratory-tract infection in primary care when pneumonia is not suspected: a 12-country, randomised,
placebo-controlled trial. Lancet Infect Dis. 2013 Feb;13(2):123-9. doi: 10.1016/S1473-3099(12)70300-6. Epub
2012 Dec 19.
11: Francis NA, Melbye H, Kelly MJ, Cals JW, Hopstaken RM, Coenen S, Butler CC. Variation in family physicians'
recording of auscultation abnormalities in patients with acute cough is not explained by case mix. A study from
12 European networks. Eur J Gen Pract. 2013 Jun;19(2):77-84. doi: 10.3109/13814788.2012.733690. Epub 2013
Apr 2.
12: Wood F, Phillips C, Brookes-Howell L, Hood K, Verheij T, Coenen S, Little P, Melbye H, Godycki-Cwirko M,
Jakobsen K, Worby P, Goossens H, Butler CC. Primary care clinicians' perceptions of antibiotic resistance: a
multi-country qualitative interview study. J Antimicrob Chemother. 2013 Jan;68(1):237-43. doi:
10.1093/jac/dks338. Epub 2012 Sep 4.
Website The organisation has no website
Maciek Godycki-Cwirko and Theo Verheij
EPCCS WSIG Report to WONCA Europe Council 2014, Lisbon
Background
The EPCCS remains a generalist society with an expert focus, founded in 2000, aiming to provide a support,
education, research, and policy focus on issues relating to cardiovascular disease within primary care settings.
Cardiovascular disease represents the single most important disease presenting to primary care physicians in
Europe, based upon its position as the number one cause of death (through myocardial infarction and stroke),
the commonest cause of premature death (before the age of 65) and the principal cause of patient disability.
Furthermore, cardiovascular disease is a consequent high cost to health care systems throughout Europe, with
two of the commonest manifestations of cardiovascular disease, namely stroke and heart failure, occupying the
top two most costly conditions to treat. Focusing on the better prevention of CVD and management of those
with disease is a priority for all of European healthcare.
The focus of the EPCCS is directed on the interests of those working within primary care and aims to utilise the
considerable evidence base that currently exists and to contribute to extending the evidence base where
appropriate. Importantly, the EPCCS is not about GP specialism per se (though ‘GPs with a special interest’ have
much to gain from the EPCCS too), but about helping physician and nurse generalists working in the community
maintain an up to date approach to patients presenting with vascular disease or enabling CVD prevention. The
initial emphasis for the Society is upon the education of practitioners. Amongst the current activities of the
EPCCS are symposia, organised around major primary care and specialist meetings, newsletters, and advice on
healthcare guidelines and policy.
Activity in 2013
Educational meetings
Specialists: We supported the organisation and delivery of educational meetings in joint symposia with
specialists at major specialist CV meetings, especially the European Society of Cardiology (ESC) Heart Failure
and CV Prevention Associations meetings and the main 2013 ESC Congress (the largest medical meeting in the
world). These activities ensure that specialists are more aware of CV issues that face GPs in their practices and
at the interface with hospitals, and provide content relevant sessions for generalists attending these major
meetings.
General practitioners: In addition, the EPCCS has continued to support PC congresses, with two EPCCS
Workshops at WONCA Europe 2013 (which were well attended and had excellent feedback), focusing on heart
failure, hypertension, and AF stroke prevention. It is worth noting that the delivery of our WONCA sessions
remains compromised by very late confirmations of which submitted sessions are accepted and especially
when in the programme they will be timetabled.
We also contributed to CV sessions at the 2013 Primary Care Diabetes Europe (PCDE) meeting in Barcelona to
600 delegates. Finally, we organised and ran the sixth two day EPCCS/WONCA WSIG Annual Masterclass
meeting in London in the first week in September 2013 – a very successful event with 400 delegates from 22
European countries and very high delegate feedback on the quality and clinical relevance of the sessions.
Newsletters & EPCCS Website:
We regularly publish articles in the Primary Care Cardiovascular Journal (which has a circulation of over
20,000). We have also significantly invested in an interactive website at www.epccs.eu which contains
increased information on meetings and provides educational resources for GPs.
Guideline development: T
he EPCCS works closely with the ESC Council for Cardiovascular Care to support primary care representation on
the writing committees for all the ESC guidelines, one of the most influential and cited guideline providers on
cardiovascular topics in the world. We also provide independent reviewers for all the ESC draft documents. This
is an important role to guide better and more relevant guidance for primary care, but also influence the ESC in
how they further promulgate their policy lobbying at the EU.
WONCA SIG:
The role of the EPCCS in this capacity was renewed during 2011
The future
The EPCCS continues to believe that closer working relationships between the WSIGs and the WONCA Europe
Board remains desirable. This collaboration could be in a number of areas:
• Better and evidence based clinical care remains a priority for us all, especially for the major disorders
that occupy a high proportion of primary care workload. We believe that the WONCA Europe meetings
are stronger if they include a good proportion of clinically relevant content and the WSIGs are underor rather variably utilised in assisting WONCA to deliver such programmes. We would happily work
with the country organisers to design (and provide if requested) content on CVD for WONCA meetings
and we believe that the WONCA Board should seek less variation between annual meetings in their
use of the WSIGs. We believe the sections of the programme for the WSIGs should be constant and
determined in advance
• We believe that WONCA should seek to endorse more collaborative meetings that have high scientific
content, including with our specialist colleagues who would benefit from better understanding the
issues and impediments to better clinical care in community settings, and visa versa, eg with the ESC.
• We would still welcome a focused debate on clinical or health system policy statements from WONCA
Europe and how these might be drafted, debated, and adopted, with appropriate input from the
collective of WSIGs. Many of the most important areas of clinical practice, such as CVD, GI disease,
diabetes, respiratory disease, are represented in WSIGs but some important areas are not, such as
mental health. A discussion with the WSIGs and the standing WONCA subgroups (like EuroPrev) might
provide a forum for a comprehensive review and options for a more strategic provision of ‘specialist’
interest across WONCA.
• Importantly, the EPCCS reiterates that we have no interest in creating a cardiovascular ‘sub-specialty’
within primary care. We seek, as all the WSIGs, to assist community generalist practitioners to
maintain an informed and up to date clinical interest in aspects of their work that carry a high patient
load, involve complex care, or both. The EPCCS remains a WSIG that supports the generalist in the
complexities of CVD care. We believe that working more closely with the subordinate WSIGs will only
strengthen the core functions and the relevance to practitioners of WONCA Europe.
International Primary Care
Respiratory Group (IPCRG)
Annual Report 2013
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Who we are
The IPCRG is an international primary care non-governmental organisation (NGO) with a special interest in
long term lung conditions such as chronic obstructive pulmonary disease (COPD), asthma, allergic rhinitis,
other common primary care respiratory problems such as respiratory infection, as well as tobacco
dependence. We have a philanthropic mission to initiate, share and spread evidence for the public good. The
IPCRG is the primary care representative on WHO-Global Alliance against Chronic Respiratory Diseases
(GARD) Planning Executive, the Respiratory Special Interest Group of WONCA Europe and an Organisation in
Collaborative Relations with WONCA Global, a member of the European COPD Coalition, a supporter of the
NCD Alliance and a member of the m-health Alliance.
What is our reach and spread?
The IPCRG is both an organisation of organisations and a global community of practice. The IPCRG members are
national primary care groups with a respiratory interest. We currently have 22 full members, for example, the
Primary Care Respiratory Society-UK, CAHAG in the Netherlands, the Chest Research Foundation India and
IPCRG-Pakistan. Through our members we reach at least 125,000 primary care professionals worldwide. We
also have 25 associate member countries. Our associate membership scheme also includes associate corporate
members, associate invited organisations including the European Federation of Allergy and Airways Diseases
Patients' Association (EFA), World Allergy Organisation and Education for Health as well as invited specialists
including Stephen Holgate, Jean Bousquet, Claudia Steurer-Stey, and Alvaro Cruz. We have close working
relationships with the European Respiratory Society (ERS), for whom we wrote the primary care chapter of the
White Book 2013, and populate the membership of the Primary Care Group within ERS. We have also
supported the recent establishment of a primary care group within the European Academy of Allergology and
Clinical Immunology (EAACI) and its leadership is also mainly drawn from our members.
What do we do?
We test and demonstrate best primary care practice. We develop and mobilise national primary care
respiratory groups. We initiate networking between colleagues from different countries who share similar
practical and research questions, data and learning about the prevention, diagnosis and management of long
term lung conditions in low, middle and high income countries. We operate virtually, complemented by annual
scientific and task force meetings. Our flagship programmes include our primary care research meetings,
bienial international conference, E-Quality delivering locally acceptable and outcomes-driven educational
programmes, E-Faculty that equips primary care teams with the skills to conduct local real-life respiratory
research and our FRESH AIR and UNLOCK research programmes.
Primary care clinicians join us because we are fast on our feet, responsive to their needs, deliver good
outcomes and are fun to work with.
The IPCRG is a charitable company registered in Scotland that operates globally.
This document is also available online at www.theipcrg.org Words in pink are hyperlinked in the online version
to the relevant resource.
Board of directors during 2013
President:
Associate Professor Niels Chavannes
General Practitioner, Department of Public Health
and Primary Care Leiden University Medical Center
President Elect:
Dr Ron Tomlins
General Practitioner and Adjunct Associate Professor,
Discipline of General Practice, University of
Sydney, Australia.
Immediate Past President:
Dr Miguel Roman Rodriguez
General Practitioner, Centro de Salud Son Pisa,
Palma de Mallorca, Spain
Treasurer: Ms Kristine Whorlow
Chief Executive Officer, National Asthma Council
Australia
Dr Karin Lisspers
Gagnef Primary Health Care
Centre, Gagnef, Department of
Public Health and Caring
Sciences, Family Medicine and
Preventive Medicine, Uppsala
University, Sweden
Directors:
Dr Jaime Correia de Sousa
Family Physician, Porto,
Portugal, Associate Professor
Community Health, School of
Health Sciences, University of
Minho
Dr Ioanna Tsiligianni
General Practitioner, Chair of
2014 Conference Organising
Committee, Heraklion, Crete
Dr Tan Tze Lee
Family Physician, The Edinburgh
Clinic, Adj Asst Prof & Visiting
Consultant, Dept of Medicine,
National University Hospital,
Singapore
In attendance:
Dr Anders Østrem
General Practitioner,
Oslo, Norway
Our country members
Each full member of the IPCRG appoints one individual as a member of the Senate to vote at general meetings.
The function of the Senate is to advise and assist the Directors and act as ambassadors of the IPCRG. In 2013
the Senate included (* newly elected members):
Australia, National Asthma Council Australia Bangladesh, IPCRG-Bangladesh
Belgium, Belgian Primary Care Respiratory Group (BPCRG) Canada, Family Physician Airways Group of
Canada
Chile, Grupo de Respiratorio de Atencio n Primaria (GRAP) Cyprus, Cyprus Respiratory Group
Denmark, Danish Respiratory Group Greece, Greek Primary Care Respiratory Group (GPCRG)
India, Chest Research Foundation India (CRF)* Ireland, Irish Respiratory Group
Italy, Societa Italiana Interdisciplinare per le Cure Primarie (SIICP)
New Zealand, New Zealand Primary Care Respiratory Group Norway, Lunger i Praksis Pakistan, IPCRGPakistan
Portugal, Portuguese Association of Family Physicians - respiratory group, GRESP
Singapore, COPD Association Singapore* Spain, Grupo de Respiratorio de Atencio n Primaria (GRAP)
Sri Lanka, Primary Care Respiratory Group, Sri Lanka Sweden, Swedish Respiratory Group in Primary Care
The Netherlands, CAHAG UK, Primary Care Respiratory Group-UK (PCRS-UK)
Viet Nam - Primary Care Respiratory Group - Viet Nam (Cham Sóc Hô Hap Ban Dau)*
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Our associate corporate members in 2013 were Boehringer Ingelheim, Mundipharma, Novartis, Pfizer, Teva
and Vitalograph whose collaboration we appreciate, and with whom we shared our experiences and insight
about the international development of primar y care and the population need for respiratory care. The Board
is advised by sub-committees and task groups. During 2013 these sub-committees were Governance chaired by
Ms Kristine Whorlow, Education led by Dr Hilary Pinnock, Research chaired by Prof Mike Thomas, the 2013
Scientific Programme Committee chaired by Drs Karin Lisspers and Björn Ställberg, the 2014 Scientific
Programme Committee chaired by Dr Ioanna Tsiligianni and the web task group including Drs Miguel Roman
and Janwillem Kocks. An Executive Officer, Siâ n Williams, is appointed by the directors to manage the day to
day operations of the charity with support from Business Manager, Samantha Louw assisted by Administrative
Assistant, Lucy Searles.
What we do: objectives and activities
The Board’s Strategic Plan was reviewed in November 2012. Therefore during 2013 the IPCRG made progress
on four strategic objectives:
1. Promote good clinical respiratory practice
2. Actively lead the respiratory health research and education agenda
3. Identify and unlock the global potential of flagship products
4. Appreciate and strengthen the core business enablers
Our performance is set in the global context of chronic lung disease now ranked by the United Nations as one
of its top four health challenges in non-communicable disease. This has prompted us to prioritise and
strengthen our networking with not only new colleagues who approach us, but proactively in the BRICA
countries of Brazil, Russia, India, China and east Africa.
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1. Promote good clinical respiratory
practice
The IPCRG believes the best way it can add to this agenda is to offer demonstrations of effective and
innovative ways forged in the real world of primary care. Some of our GP colleagues in Europe see 30-40
patients a day, others, for example in Pakistan, up to 200 patients a day, bothered by a range of minor and
serious respiratory infections and chronic illness; our examples need to reflect that diversity and complexity.
In order to meet local needs and align with local healthcare systems, culture and access to medicines, we
continue to follow our mantra: we work locally, but collaborate globally.
Guideline mapping
We are not a guideline group, but we do believe there is a role for guidelines to improve the consistency and
reliability of care. However, unless guidelines draw on evidence that reflects the real patients and resources
with which primary care works, they will be disregarded as irrelevant. Therefore, we mapped the respiratory
guidelines used in primary care, asking our members how they were constructed and if primary care was
involved in their production. The overall aim of the mapping was to create a resource on the IPCRG web
platform that enables members and health planners to easily and quickly share information and learning about
national clinical guidelines used by primary care for COPD, asthma, allergic rhinitis, CAP, obstructive sleep
apnoea (OSA), and stop smoking. The resource is searchable by topic or on a particular country or a
combination of topic and country. A snapshot summary and analysis is available here and the full resource
here.
Policy influence
Many health systems are responding to the World Health Organization’s guidance to invest in primary care as
the most cost-effective way to address the burden of both infectious and non-communicable disease in the
next decades and to achieve the “grand convergence” between low, middle and high income countries
described by the Lancet Commission. We have members with over 20 years’ experience of developing primary
care to case-find and manage respiratory disease and also members who are just setting out on that journey.
We play an important role in helping colleagues learn from each other about how best to work with hospital
colleagues, and how to build up primary care expertise rapidly. The Primary Care Chapter of the ERS White
Book is our 2013 policy contribution to this in Europe. In addition, we have worked with colleagues in Brazil,
India, Greece and Uganda to understand how primary care and community health workers can be supported to
increase their knowledge and skills so that patients do not need to attend hospital for common and treatable
chronic lung problems.
Conferences
Our conferences offer a platform for primary care colleagues to share and debate real life examples of best
practice, including how to reduce variation in care, how to improve respiratory outcomes and how to do this
with limited time and resource. At our third one-day Scientific Meeting in Uppsala, Sweden in May, there were
190 primary care innovators and early adopters from all four continents and 83 abstracts were presented of
primary care respiratory research. This represents a real growth in worldwide primary care respiratory research
capacity and the potential to start to influence policy and practice.
Winners of our 2013 Research Awards
(left to right: Dr Annemarije Kruis, Netherlands,
Dr Javiera Corbalán Pössel, Chile;
Dr Hanna Sandelowsky, Sweden)
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World Health Organization
The World Health Organization-Global Alliance against chronic Respiratory Diseases (WHO-GARD) has
previously endorsed a number of our projects as demonstration projects and we have continued to represent
primary care on WHO-GARD to link up theory and practice. Our President, Assoc Prof Niels Chavannes, our
Treasurer, Ms Kristine Whorlow and our colleague Dr Osman Yusuf all attended the 2013 general meeting
where support was given to national action plans that involve primary care.
WONCA
We also ran a series of respiratory workshops at the combined WONCA World and WONCA Europe 2013
conference as the respiratory Special Interest Group of WONCA Europe, which is a successful collaboration to
share and spread primary care respiratory knowledge and updates to wider family physician audiences.
These workshops also give us opportunities to connect with respiratory-interested colleagues in new countries.
In 2013 we took steps to establishing groups in Slovenia, the Czech Republic and the Former Yugoslav Republic
of Macedonia and to expanding our connections in Turkey.
2. Actively lead the respiratory health
research and education agenda
Education
During the year the Education Sub-Committee chaired by Dr Hilary Pinnock reviewed its education initiatives;
identified trends in medical education and agreed a strategy for education. As part of this we undertook a
further review of literature published since 2011 and took advice from educational experts in global health.
We concluded that:
• Education remains a global concern in the management of respiratory conditions in primary care
• There is a growing evidence base supporting multifaceted (or blended) educational programmes to achieve
positive outcomes for patients and professional practice
• There is an important shift in emphasis to work with the wider system in which change is desired: from standalone educational interventions to complex interventions designed to improve delivery, practice and
organisation of healthcare
• There are new mechanisms of delivery provided both through new technology but also new research on
behaviour change and situated learning (through communities of practice).
This appeared to support the main findings and conclusions of our review in 2012, and our way of working,
which is to develop a global community of interest, with multi-national communities of practice. Consequently,
the IPCRG has enlarged our E-Quality small grant programme that calls for bids to test and evaluate real life
educational interventions that change clinical behaviour. We have also begun to specify an educational
curriculum to promote good clinical respiratory practice that improves population health.
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It accompanies a suite of practical materials to support primary care and other community healthcare
professionals to improve the assessment, review and management of people over the age of 18 years with
difficult to manage asthma. It includes a desktop helper in 8 languages, a video, practical free tools for use in
primary care and an ideal referral letter. The material was presented during the ERS Primary Care Day attended
by over 400 clinicians, most new to the IPCRG. The way it was achieved is also a model that can be reproduced
for other topics.
Research
Policy
During 2013 we teamed up in Europe with our associate members the European COPD Coalition (ECC), EFA and
the Lithuanian EU Presidency to deliver an event to mark World COPD Day 2013 that focused on the
implications of the research funding programme “Horizon 2020” on patients, healthcare professionals,
academia and European citizens.
We highlighted that the European costs from COPD, 141 billion, presently exceed the investment in Horizon
2020, which is the highest funded research programme in Europe and which addresses societal challenges.
“Patient-driven standards on prevention, diagnosis, care and rehabilitation have to be better measured. There is
an urgent need to use this data to drive and improve patient outcomes,“
Dr Rupert Jones
Difficult to manage asthma
The IPCRG published its Difficult to Manage Asthma Position Paper supported by EFA and funded by an
unrestricted educational grant from Novartis.
Clinical co-chairs of project:
Stephen Holgate and Dermot Ryan
Clinical authors of desktop helper:
Armando Brito de Sá,
Pascal Chanez, Javiera Corbalán,
Jaime Correia de Sousa,
Breda Flood (EFA), Liam Heaney,
Michael Hyland, Jan Lötvall (EAACI),
Björn Ställberg, Scott Wagers,
Osman Yusuf
*SIMPLES acronym: Anna Murphy
Writer and Editor: Susan Mayor
The qualitative data was presented at our Uppsala meeting and the quantitative data at the European
Respiratory Society meeting. The Group has found that respiratory symptoms are common among men,
women, and children. In several communities respiratory symptoms were stigmatised and often associated
with tuberculosis. Almost all the households used firewood for cooking and the majority cooked indoors
without any ventilation. The extent of exposure to tobacco and biomass fuel smoke is largely determined by
cultural tradition and gender, tribal origin and socioeconomic factors. Many people are unaware of the damage
to respiratory health caused by these risk factors, notably the disproportionate effect of biomass smoke in
women and children. Tobacco smoking prevalence amongst men is also very high.
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Represented by Dr Rupert Jones, we called for increasing efforts in COPD prevention; building on the success of
UBIOPRED (see page 10) more involvement of patients and primary care in EU health research projects and
policy from the planning stages and keeping them active throughout; increases in funding under H2020, to be
matched with more ambitious and strategic structuring of research aimed towards societal needs; decreasing
existing health inequalities by including COPD patients in discussions and planning at national level and through
European Commission actions to avoid discriminatory practices, for example airline policies.
In particular we highlighted the importance of primary care in providing earlier diagnosis of COPD for patients
and in encouraging self-management of the disease. Research in primary care could identify the missed
opportunities to diagnose patients. We also explained the role of primary care to inform and educate patients
about their diagnosis and how to manage it.
FRESH AIR
Our FRESH AIR programme investigating the level and impact of exposure to tobacco and indoor biomass
smoke has demonstrated how research can be conducted in low income countries in a way that truly engages
the local community and copes with limited local clinical knowledge and research capability in chronic disease.
For a summary of this programme see theFRESH AIR documentary
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Galvanising and franchising the IPCRG FRESH AIR movement
In November, following conversations begun at WHO-GARD, Dr Beraki Ghezai travelled to Kyrgyzstan as guest
of the National Center of Cardiology and Internal Medicine and the Kyrgyz Thoracic Society and signed a joint
memorandum of understanding to adapt the FRESH AIR protocol to its mountainous environment and to
initiate a primary care respiratory group. We hope to expand the FRESH AIR movement each year by adapting
and using the protocol in a range of low and middle income countries where indoor biomass is a potential risk
to lung health.
UNLOCKing primary care data for multi-national comparison UNLOCK is an international collaboration between
primary care research members of our network aiming to coordinate and share datasets of relevant diagnostic
and follow-up variables of their COPD and asthma patients managed in primary care. The protocol summary
was published in the Primary Care Respiratory Journal in 2010. In March a letter written by UNLOCK members,
drawing on our work was published in Lancet Respiratory Medicine: During the year we made progress on four
projects and learnt a great deal about how to solve coding discrepancies, different national standards of data
protection and research ethics, as well as cultural and demographic differences between populations and
clinicians in the countries involved. We also opened up UNLOCK to researchers with asthma datasets. The
UNLOCK Group now includes groups from the UK, Netherlands, Sweden, Germany, Norway, Greece, Portugal,
India, Canada and Chile. To read more, go to the UNLOCK pages.
In 2013 UNLOCK agreed to collaborate with the Respiratory Effectiveness Group (REG), which is an investigatorled research initiative that brings together respiratory specialists with expertise and/or an interest in real-life
research with an aim to raise the profile of real-life research in academic, political, regulatory and public arena.
The IPCRG President, Assoc Prof Niels Chavannes, and the IPCRG Chair of Research, Prof Mike Thomas
represent UNLOCK on the REG Steering Committee.
GOLD COPD categories are not fit for purpose in primary care
“We suggest that COPD severity assessment should take into account a range of items such as spirometry,
smoking, exacerbations, health status, and comorbidities; this could be done using multi-component indices
such as Body mass index, airflow Obstruction, Dyspnoea, and Exercise capacity (BODE), Age, Dyspnoea and
airflow Obstruction (ADO), or the Dyspnoea, Obstruction, Smoking, Exacerbation index (DOSE). Management
should follow an evidence-based algorithm involving smoking cessation, pulmonary rehabilitation, and drug
treatment. We urge that any new treatment algorithm aimed at primary care clinicians fully involves members
of that community in its production, and is piloted and evaluated rigorously in primary care settings before
dissemination. “
www.thelancet.com/respiratory Vol 1 March 2013
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UBIOPRED
We continued to provide the primary care input into UBIOPRED, a major European Union Innovative Medicines
Initiative. The importance of both primary care and patient involvement in research design and implementation
has been increasingly accepted within the European Commission. Building on the successful 2013 ERS Primary
Care Day on asthma, difficult to manage asthma and severe asthma, we have agreed a dissemination plan to
primary care through a series of national workshops in collaboration with the European Federation of Allergy &
Airways Diseases Patients' Associations (EFA). This will start in 2015 once the findings are published. We intend
to debate the future of person-centred care and the role for stratified prescribing. IPCRG Research Pilots At our
Scientific Meeting in Uppsala we extended the event by a day to host a research design workshop that asked
what research could the IPCRG fund to address some of the IPCRG’s published Prioritised primary care
respiratory research questions. The outcome was support for three proposals that will begin work in 2014:
• Pain in COPD Survey Study coordinated by Prof Darlene Reid, Canada.
• The development with the local Masindi community of an education and m-health intervention led by
the FRESH AIR Uganda team of Drs Bruce Kirenga, Frederik van Gemert and Rupert Jones. This will
incorporate a small-scale study of post-TB rehabilitation also initiated in 2013.
• Objective 1 of a stop smoking in primary care project led by Dr Andy McEwen, National Centre for
Smoking Cessation and Training (NCSCT), UK to determine the extent and nature of tobacco treatment
guidelines for primary care.
We have also commissioned a review of asthma control tools that will identify any new tools or translations
since the publication of our original guide in 2005. This is a companion piece to our published review of COPD
assessment tools that has been accessed frequently.
Building research capability
The IPCRG fellowship programme
During 2013 we finalised the arrangements for the first IPCRG Fellowship Programme for a doctoral candidate
as a way to enhance research capacity in low and middle income countries (LMIC). This is multi-national
collaboration between four universities and the IPCRG:
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• Family Medicine Department, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
• Clinic of Social and Family Medicine, University of Crete, Heraklion, Crete, Greece
• Primary Care Research, University of Southampton, Southampton, UK
• Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
• International Primary Care Respiratory Group, London, UK
The first Fellow is Vinh Nguyen, now resident in Crete, Greece and under the tuition of Professor Christos Lionis
and colleagues in Heraklion.
We will be evaluating if such a collaboration develops research capacity in the respiratory primary care field; if
the experiences gained by working in different settings and cultures can be applied in a LMIC setting; what
experiences can be gained through international and intra-cultural collaboration in research and clinical
practice and the non-visible factors that may explain the variation of respiratory morbidity in different settings.
E-Faculty
Our E-Faculty project that aims to improve research capacity in primary care research-naive teams is now
working in Chile. The team has joined the UNLOCK programme and is collecting new data on asthma as the
healthcare system shifts its focus from respiratory infection to chronic lung disease.
Young researchers
We have engaged with the Vasco da Gama movement, the young doctor programme within WONCA Europe
and in particular with their research group. Colleagues are now part of the abstract reviewing team for
RespiratoryAt@Glance
We have also started planning for a joint Vasco da Gama /IPCRG prize in 2014.
3. Identify and unlock the global potential
of flagship products
Conferences
In addition to our very successful 3rd Scientific meeting in Uppsala we began preparation in earnest for our 7th
biennial world conference in Athens in 2014 and engaged many of our network in the design of a programme
that will address multi-morbidity, which is highly relevant for a primary care audience. In addition to colleagues
in Europe and North America we reached out to colleagues in Brazil, India, China and Malaysia to advise us and
connect with us. This will be followed by our 4th Scientific Programme for which planning has started and will
take place in May 2015 in Singapore, the first of our Scientific Meetings to take place outside Europe.
E-Quality programme
The E-Quality programme contributes to our knowledge about primary care education, service improvement
and outcomes for clinicians and patients. From the IPCRG E-Quality programme Call 1 the Chest Research
Foundation, Pune, India made progress on the evaluation of one-day asthma education programme, CHAMPS
for GPs who do not prescribe inhaled medicines. The team overcame the challenges of research design and
approval as well as recruitment during the year and expects to report in 2014.
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From Call 2 we continued to support the Brazilian team in an ambitious matrix programme in Sao Bernardo Da
Campo, São Paulo. As well as supporting the team through our Portuguese group, we tested the approach of
providing English coaching to the project lead, Dr Sonia Maria Martins to increase the numbers of the IPCRG
network who could offer support. Two colleagues, Drs Javiera Corbalán Pössel from Chile, and Jaime C de
Sousa, from Portugal presented their perspectives on COPD and asthma management at a meeting in North
Brazil. Our collaborators include the Brazilian Society of Family Medicine and Community, the Medical College
ABC – FMABC and GINA – Brazil.
"...the professionals are highly motivated by educational programs and identified that there is a high prevalence
of asthma and COPD in the area and identified as a priority the need for an approach to improve chronic
respiratory diseases. We noticed in the discussions that the teams are making in this unit more diagnosis and
treatment, which has left us very happy.” The E-Quality Educational Program is encouraging provided care and
reflections about changes in the work processes of teams and in the interaction between network services,
triggering processes for the implementation of a comprehensive network of care for asthma and COPD.” [EQuality First Annual Report] “First you give us a theoretical basis, and then sit down to meet us, this is very
important “ [Participant feedback]
Also from Call 2, Dr Beraki Ghezai made an initial site visit for our project in Eritrea and we now await
Government approval to begin teaching. Further information about our other flagship projects can be found
here:
E-Quality Quality+Programme Position Statements and Desktop Helpers Respiratory At@Glance in English
and Spanish as an in-kind donation from Teva Pharmaceuticals Ltd, and Flu At@Glance donated by Stimumind.
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4. Appreciate and strengthen our core
Primary Care Respiratory Journal (PCRJ)
During the year we supported our UK group, PCRS-UK, which tendered for the publishing of the Primary Care
Respiratory Journal (PCRJ), our official journal. The contract was signed early in 2014 with Nature Publishing
Group. This will move the journal online only and to an author-pays model, and it will be renamed npj Primary
Care Respiratory Medicine. Editorial control will remain with the Editors in Chief. Another nine associate editors
were appointed from a strong and enthusiastic field, showing the international interest in the journal. Its
Impact Factor continues to rise, and we expect it to have moved from 2.2 to over 2.5 by early 2014, judging by
current levels of citations.
Member spread and impact
During 2013 we increased the numbers of researchers actively working with the IPCRG, both highly
experienced experts, and also primary care clinicians keen to embark on research as a career or as part of a
portfolio of work. We also welcomed new member countries and enquiries that we believe may lead to new
groups. Our relationship with WONCA Europe continued to strengthen, and our collaborations are summarised
on our web platform here
In May 2013 at the 66th World Health Assembly, the WHO Global NCD Action Plan (GAP) 2013-2020 was
agreed including six objectives and nine voluntary targets. The IPCRG’s members assist governments at a
national and international level. In particular, they support achievement of three objectives:
GAP Objective 2 To strengthen national capacity, leadership, governance, multisectoral action and partnerships
to accelerate country response for the prevention and control of noncommunicable diseases.
Examples
• GRESP members are involved in the Portuguese National Guideline Quality Assessment Board and in the
National Plan for Respiratory Diseases
• PCRS-UK members ran another successful Respiratory Leaders programme
• FPAGC represented primary care on the Canadian guideline groups for asthma, COPD, sinusitis, alpha-One
Antitrypsin deficiency, and smoking cessation
• IPCRG-Viet Nam participated in writing their national asthma guidelines
• Greek Primary Care Respiratory Group and the University of Heraklion have been cooperating on an EUfunded project to create 16 primary care guidelines including COPD and asthma. IPCRG has coordinated the
involvement of two other groups, GRAP, Spain, and the Asthma Society Ireland, to advise based on their
experience
GAP Objective 4 To strengthen and orient health systems to address the prevention and control of
noncommunicable diseases and the underlying social determinants through people-centred primary health
care and universal health coverage
Examples
• GRESP Portugal organised its 2nd Training-the-Trainers GRESP Course that took place in February 2013 (five
Saturdays) and participated in the Brazilian National Family and Community Medicine Conference in Belém.
• The Greek PCRG has trained over 300 GPs at 4-day COPD schools and smoking cessation schools.
• Between May and November 2013 the Chest Research Foundation India trained 684 general practitioners,
general physicians, paediatricians and respiratory technicians and medical trainees and offered a free 6-weekly
2-hour webcast to which 600 trainees log in each time.
• FPAGC Canada ran the Mainpro C Spirometry program at individual provincial College of Family Physician
assemblies, national College of Family Physician assembly, and Primary Care Today annual meeting, teaching
spirometric interpretation to hundreds of primary care physicians
• IPCRG-Viet Nam with with University Medical Center Ho Chi Minh City organized an asthma-COPD patient
club meeting for 150 people. Participants were recruited by advertising on newspapers and radio (see front
cover).
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GAP Objective 5 To promote and support national capacity for high-quality research and development for the
prevention and control of non-communicable diseases.
Example
The two arms of UNLOCK (COPD and asthma) are being launched in Portugal as a partnership between the
IPCRG, GRESP/APMGF and the Research Institute from the School of Health Sciences in Minho University.
Researchers are being recruited and a project for a grant application is being written. The ICAPP study
(Improving Asthma Care in Portuguese Patients) is investigating the effectiveness of an electronic medical
record in the control of asthma and rhinitis in primary care patients and developing studies in adherence,
concordance and enablement.
Finally, in terms of governance, the IPCRG published its anti-bribery principles
Future plans 2014-2016
We summarise here our objectives for the next three years:
Future plans 2014-2016:
• Advocate for primary care’s role in lung health: show practical solutions to case-finding and management in
general practice and other primary care approaches integrated in local health systems
• Demonstrate the value of primary care in managing multiple morbidities by helping people change
behaviours to stop smoking and/or inhaling indoor smoke, to eat a better diet and to increase physical activity
as well as offering safe and effective pharmacological interventions.
• Advocate for access for populations to effective respiratory medicines in primary care as part of the UN
Global Action Plan for noncommunicable diseases.
• Contribute the primary care perspective to international awareness and advocacy campaigns for COPD,
asthma, allergic rhinitis and the role of primary care working with our colleagues in ERS, ECC, EFA, EACCI, WAO,
WONCA, ICC
Future plans 2014-2016:
Some key objectives include:
Education
• Publish our educational strategy and begin to implement
Research
• Monitor the success of the first IPCRG Research Fellow in collaboration with the universities of Heraklion,
Leiden, Southampton and Ho Chi Minh
• Proceed with the first multi-national IPCRG research projects to address our research needs statement:
COPD and pain; an evaluation of stop smoking guidelines for primary care; the use of m health to improve
respiratory outcomes in low resource countries
• Support expansion of UNLOCK by creation of new cohorts in more countries
• Internationalise npj Primary Care Respiratory Medicine, working with the new publisher
Promote good clinical respiratory practice Actively lead the respiratory health research and
education agenda
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Future plans 2014-2016:
Expand these flagship products into new clinical and geographical areas:
Conference
• Deliver a successful 7th World Conference, “A Breath of Fresh Air: Multiple morbidities and integrated care”
for delegates and supporters
• Finalise plans for the 4th Scientific Meeting, and the first outside Europe: Singapore 29-30th May 2015
• Begin planning for 8th World Conference May 2016, Amsterdam
• Have a strong presence at WONCA conferences including Lisbon 2014
E-Quality: award third round of E-Quality
E-Faculty: conclude writing-up from Romania and deliver first outputs from the E-Faculty programme in Chile
FRESH AIR: Franchise FRESH AIR to new countries and use intervention mapping to address findings from
FRESH AIR Uganda
UNLOCK: Expand UNLOCK to asthma and deliver new COPD studies incorporating more datasets
with the support of an UNLOCK researcher, a joint appointment between the University of Minho, Portugal and
the IPCRG. Deliver a joint REG/UNLOCK session “The evolving role of real-life research in respiratory medicine”
at ERS 2014 chaired by Niels Chavannes
Difficult to manage asthma
programme: test national workshops and integrate the UBIOPRED programme
Future plans 2014-2016:
Further internationalisation
The IPCRG is the first point of contact for many policy-makers and organisations wanting to collaborate with,
understand, or influence, the international primary care respiratory community. We are regarded as a thoughtleader offering practical solutions on tobacco dependence, asthma, allergic rhinitis, chronic obstructive
pulmonary disease and respiratory+ infection. We are able to extend our activities further into low and middle
income countries where there are significant numbers of people at risk of long term lung disease but less
established systems of healthcare delivery. Membership We will build on contacts with new researchers and
new member enquiries to widen our membership geographically and professionally to ensure the sustainability
of the society. We will also continue to collaborate with our associate members exploring areas of synergy. For
example, we can illustrate advocacy organisations’ call for improved standards by sharing examples of the
highest possible performance in different settings; we can work with our associate corporate members to
identify respiratory-interested primary care clinicians to join our research groups or form IPCRG groups. We
plan to increase activity in Slovenia, Czech Republic, Former Yugoslav Republic of Macedonia, Turkey and
Germany aiming for full membership by 2015. We will use the planning process for our Singapore 2015
conference to engage colleagues in the colleges of general practice in Asia Pacific. Marketing the PCRM to
authors provides further opportunities to connect with and support primary care researchers.
Aligning with WHO Global NCD Action Plan through our members The IPCRG and its members will continue to
support actions to address the WHO Global NCD Action Plan’s objectives and voluntary targets in particular: A
25% relative reduction in risk of premature mortality from cardiovascular diseases, cancer, diabetes, or chronic
respiratory diseases A 10% relative reduction in prevalence of insufficient physical activity A 30% relative
reduction in prevalence of current tobacco use in persons aged 15 + years An 80% availability of affordable
basic technologies and essential medicines, including generics, required to treat major noncommunicable
diseases in both public and private facilities Identify and unlock the global potential of our flagship products
Strengthen our core: membership and communities of interest
Do you have an interest in the primary care prevention, detection and management of asthma, COPD,
tobacco dependence, allergic rhinitis, rhinosinusitis, respiratory infection in low, middle or high income
countries?
Contact us to find out more about:
Our membership schemes for industry members, individuals with an academic interest, and country groups
Our flagship programmes:
E-Quality for education that drives improvements in clinical behaviour
E-Faculty, Research Fellow that increase primary care respiratory research capability
UNLOCK: multi-national primary care cohort studies in asthma and COPD
FRESH AIR: surveys of levels of exposure to indoor and tobacco smoke and their impact
Conferences that enable sharing of primary care research,
Publications in many languages that offer practical “desktop” support

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