The discussions at the summit highlighted not only the importance of reviewing existing tools but also the practical application of successful strategies observed across different countries. These success stories underscore the feasibility of adapting and implementing Right Care Tools in various healthcare systems to improve asthma management.
New Zealand’s Three-Step AIR Treatment Guideline: A Model for Right Care
In 2020, New Zealand took a significant step towards right care in asthma management by adopting national asthma guidelines that strongly emphasized primary care involvement. These guidelines recommended Anti-Inflammatory Reliever (AIR) therapy as the preferred approach (Fig. 5). The implementation of these guidelines was supported by a comprehensive communication plan aimed at wide dissemination and practical adoption. A recent evaluation assessing the impact of these guidelines revealed a notable increase in the prescription of ICS-formoterol, a key component of AIR therapy, alongside a decrease in the dispensing of short-acting beta-agonist (SABA) inhalers since the guidelines were introduced [14]. This evidence strongly suggests that a widespread shift towards AIR therapy, as advocated by the Global Initiative for Asthma (GINA), is achievable when incorporated into national asthma guidelines. Such guidelines are most effective when developed collaboratively, endorsed by both primary and secondary care, and supported by systems that ensure medicine accessibility and fair clinician reimbursement. Furthermore, considering patient preferences is crucial as it directly influences their adherence to the prescribed medication, making patient-centeredness a vital aspect of right care tools.
Fig. 5: 2020 New Zealand AIR therapy-based algorithm showcasing a right care approach.
This algorithm exemplifies a right care tool by providing a clear, step-by-step approach to asthma treatment, focusing on anti-inflammatory relievers.
Spain’s Teachable Moments: Utilizing Pharmacists as Right Care Advocates
Spain has successfully enhanced the capabilities and confidence of community pharmacists through the Teach the Teacher® program [15]. This initiative, led by IPCRG-trained pharmacists and family physicians, recognizes the valuable opportunity presented when patients request a SABA inhaler over the counter. These instances become ‘teachable moments’ where pharmacists can effectively employ right care tools. By fostering strong relationships between patients, family physicians, and community pharmacists, Spain has begun to reshape the asthma care pathway. The focus has shifted from readily dispensing SABA inhalers on demand to utilizing Asthma Right Care tools to educate individuals, provide advice on right care practices, and encourage those with poorly controlled asthma to seek review from their family physicians [16]. This approach has yielded significant results, with a reduction of 500,000 SABA canisters sold in 2020 compared to 2018, demonstrating the impact of pharmacist-led right care initiatives.
Portugal’s Patient Engagement: A Community-Based Right Care Strategy
Portugal has adopted innovative, grassroots patient and public engagement strategies as right care tools. The ‘Caminhasma’ initiative, involving over 50 organized walks and talks planned by primary care physicians, nurses, and community pharmacists, has reached almost 4000 people. These community events, meaning ‘walk with asthma’, are designed to improve asthma literacy and awareness, acting as a proactive right care tool for prevention and education. The success of this initiative has led to its replication in Brazil, highlighting its effectiveness as a scalable right care model. Furthermore, the Asthma Right Care team, known as ‘CAPA’, has expanded its reach by co-creating educational films, conducting television interviews on health channels, and delivering clinical webinars. Currently, a new campaign targeting adolescents is under development in partnership with the Ministry of Education of Portugal. This campaign will feature a video game designed to educate young people about asthma, showcasing a modern approach to right care education.
Argentina’s National Asthma Law: Policy as a Right Care Framework
In Argentina, clinicians passionate about respiratory health have advocated for a national asthma law to ensure equitable access to care for all individuals with asthma. This legislative effort represents a systemic approach to right care, aiming to establish a framework for consistent and accessible asthma management across the nation. Separately, these clinicians have collaborated with colleagues in other specialties to raise awareness about vulnerable populations, such as pregnant women. An unpublished national survey revealed that pregnant women often discontinue their asthma medication during pregnancy, highlighting a critical gap in right care and the need for targeted interventions and education.
Tunisia’s Asthma Lexicon: Language as a Right Care Enabler
Tunisia has prioritized a SABA overuse awareness program within community pharmacies, supported by the Pharmacists Union and the Private Physicians Union. This program, endorsed by the Minister of Health, underscores the national commitment to right care in asthma management. To facilitate this program, IPCRG’s right care tools, including the Reliever Reliance Test and Asthma Slide Rule, were translated into Tunisian dialect, ensuring cultural and linguistic accessibility. Furthermore, a lexicon of Tunisian dialect asthma and allergy terms, with French and English translations, was developed. This lexicon serves as a crucial right care tool by promoting consistent terminology across the healthcare system, improving communication and understanding between healthcare providers and patients.
These diverse success stories collectively illustrate the value of bottom-up approaches that actively involve primary care and patients. By emphasizing education and advocating for systemic change, these initiatives address the challenges of episodic care and promote the adoption of comprehensive right care tools and strategies for asthma management worldwide.
Nine Statements for Improved Respiratory Care: Global Right Care Principles
Delegates at the summit were presented with and endorsed nine key actions aimed at enhancing respiratory care. These statements, agreed upon by IPCRG and WONCA Europe at the 2023 WONCA Council meeting (Fig. 6), serve as guiding principles for implementing right care on a global scale.
Fig. 6: Nine statements agreed with IPCRG and WONCA Europe to improve respiratory care, embodying right care principles.
These nine statements represent a consensus on essential actions for improving respiratory care globally, forming a robust framework for right care implementation.
