9 th European Health Forum Gastein Gastein, Austria, 5 October Francis P. Crawley. Director General Good Clinical Practice Alliance - Europe

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1 Chairman s Opening Remarks Achieving Best Care and Treatment Practices for European Asthma Patients Lunch workshop Promoting cross-border exchange of best practices the Finnish asthma experience 9 th European Health Forum Gastein Gastein, Austria, 5 October 2006 Francis P. Crawley Director General Good Clinical Practice Alliance - Europe 1

2 How can we achieve the highest standards of care in asthma prevention, diagnosis, and treatment for all of Europe s patients?

3 Identifying patient needs (through full interaction with patients and their organisations) Collecting and directing European-wide medical expertise Attaining government and industry commitment to implementing and supporting best practices Modeling European cross-border standards for patient-centred care and treatment A Patient-centred & European-wide Cross-border Cooperative Approach

4 Today s Discussion Setting the Agenda A European success story the Finnish Asthma Programme ( ) Caretakers and patients crossing borders Settling a European framework for discussion Concrete steps the way forward

5 Expertise and Leadership Starting a Discussion Erkka Valovirta Chairman, Allergy Section, Finnish Society of Paediatrics Eero Lahtinen Ministerial Adviser, Finnish Ministry of Social Affairs and Health David Price Chair of Research Committee, International Primary Care Respiratory Group (IPCRG) Susanna Palkonen Executive Officer, European Federation of Allergy and Airways Diseases Patients Associations (EFA) Daniel Mann Health Information Unit, DG SANCO, European Commission

6 PROMOTING CROSS-BORDER EXCHANGE OF BEST PRACTICES THE FINNISH ASTHMA EXPERIENCE The Finnish Asthma Programme Erkka Valovirta, M.D., Ph.D. Paediatrician, Paediatric Allergist Turku, Finland

7 To design a national programme to Decrease the burden of asthma To reduce of the costs Partners: Min of Social Affairs and Health Min of Environment Social Insurance Institution Finnish Ass of Lung Physicians Allergy and Asthma Federation, NGO Pulmonary Association HELI, NGO Asthma Working Group appointed by the Ministry of Social Affairs and Health

8 National Asthma Follow-up Group appointed by the Ministry of Social Affairs and Health To implement the programme regionally and locally May 1996 Dec 1998 Partners: Min of Social Affairs and Health Min of Environment Social Insurance Institution Finnish Ass of Lung Physicians and Paediatricians Allergy and Asthma Federation NGO Pulmonary Association HELI NGO Reps from GPs and nurses Pharmacists Coordinated by FILHA

9 Regional education Coordinated by FILHA (NGO) since 1999 Direct cost of the programme was 0.65 million icluding from the Ministry of Social Affairs and Health who also gave their political commitment to the programme The intervention was managed by intergrating the tasks into everyday practice of the healthcare staff Most of the activities were a part of the clinician s and administrators routine work

10 Goals of the Asthma Programme 1) As many patients as possible with early asthma recover 2) Asthma patients feel well, and their working and functional capacity correspond to their age 3) The percentage of patients with severe and moderate asthma falls from the current (in 1994) 40% to 20% 4) The number of bed-days of asthma patients decreases by 50% by the year 2000, that is to 50,000 a year 5) The annual costs per patient fall 50% as a result of more effective prevention and treatment

11 Measures to achieve the goals 1) Early diagnosis and active treatment 2) Guided self-management as the primary form of treatment 3) Reduction in respiratory irritants such as smoking and ETS 4) Implementation of patient education and rehabilitation combined with normal treatment, planned individually and timed appropriately 5) Increase in knowledge about asthma in key groups 6) Promoting scientific research A 10 year asthma programme in Finland: major change for the better.

12 Working strategy and implementation Implementation of new knowledge, especially for primary care Main premise underpinnig the campaign: asthma is an inflammatory disease and requires anti-inflammatory treatment from the outset Keys for implementation: Effective network of asthma-responsible professionals (GPs n=200, nurses n= 580) in each Finnish healthcare centre (n=271) Development of a post hoc evaluation strategy The patient, and the parents, and the attending HCP and the unit shall bear the primary responsibility for the asthma treatment

13 DID WE ACHIEVE THE GOALS? 1) As many patients as possible with early asthma recover - the number of children and adults with new special reimbursement reached a turning point in 2001 and is decreasing 2) and 3) Asthma patients feel well, and their working and functional capacity correspond to their age.decline in percentage of patients with severe and moderate asthma from 40% to 20% - patients with severe complications have substantially decreased, as have physical limitations - the absolute numbers of hospitalisation days, disability pensions, allowances for days off work and need for rehabilitation have all decreased 30-50%

14 DID WE ACHIEVE THE GOALS? 4) The number of bed-days of asthma patients decreased by 50% by the year 2000, that is, by 50,000 a year - the number of days hospitalised has fallen by 56% from in 1993 to in 2003, and in relation to the number of asthmatics by 70%. The trend is still downwards.

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17 Incidence of asthma patients (%) acc to the special reimbursement register in 2004 by age group

18 DID WE ACHIEVE THE GOALS? 5) The annual costs per patient fell by 50% as a result of more effective prevention and treatment - When compensation for disability, drugs, hospital care and outpatient doctor visits are taken into account, costs per patient have decreased (related to the increase in gross national product) by 50%

19 Asthma costs in 1993 and billion 200 Costs (billion ) % 20 % Disability Medication Hospital days Doctor visits % 0 16 % /patient Haahtela et al.thorax 2006

20 Asthma costs in 1993 and billion billion Costs (billion ) % 20 % 25 % 37 % Disability Medication Hospital days Doctor visits % 10 % 0 28 % 16 % /patient 1031 /patient - 36% Haahtela et al.thorax 2006

21 Summary and challenges for the future Programme has been successful: Programmed collaboration between different stakeholders Most activities a part of daily routine clinical work Resources and know-how are better Timely proper diagnosis in primary care Patients feel well, the number of disability pensions and hospital days have decreased Challenges: To maintain the achieved situation To develop asthma education and rehabilitation To develop a follow up system

22 A 10 year asthma programme in Finland: major change for the better T Haahtela, L E Tuomisto, A Pietinalho, T Klaukka, M Erhola, M Kaila, M M Nieminen, E Kontula, LA Laitinen Thorax 2006;61:

23 Towards better asthma management across the EU what needs to be done from a primary care perspective Professor David Price, Chair of Research Committee, International Primary Care Respiratory Group (IPCRG)

24 Good or Complete Control over Severe Persistent Asthma Vermiere PA, et al. Respir Med. 2002;96:

25 Asthma Treatment Limitations: United Kingdom Percent of Patients Overuse of Rescue Medication 10 Lost Days from School/Work 32 Poor Adherence 10 Poor Inhaler Technique McCowan C, et al. Primary Care Respiratory J. 2005;14:

26 Reasons for poor asthma control Inappropriate changes made Patient not reviewed Poor integration Inadequate assesment Asthma education and treatments need to be improved!

27 Ways to improve asthma care in Europe! Use validated instruments (such as patient questionnaires) to assess asthma control and identify reasons for poor asthma control! Provide feedback of results to health care professionals! Reaudit at 1year! IPCRG/EFA s E-SPACE project (Enhancing and Strengthening Peadiatric Asthma Care in Europe): Testing asthma assessment tool among 6,000 patients (aged 6-15 years) in 3 pilot countries (UK, Netherlands, Poland) Rolling-out the asthma assessment tool in 10 additional European countries (Austria, Belgium, Bulgaria, Czech Republic, France, Germany, Greece, Italy, Norway, Portugal).

28 Towards better asthma management across the EU The Patients Perspective Susanna Palkonen European Federation of Allergy and Airways Diseases Patients Associations (EFA)

29 FA Survey European Patient Perspective on Severe Asthm Fighting for Breath

30 the PROBLEM "Inadequate communication and partnership "Insufficient research "Unsatisfactory health care "Involuntary exposure to pollutants

31 the CONSEQUENCES # Compromised lives # Unnecessary illness # Social isolation # Preventable deaths

32 the SOLUTION # Patient-centered expert care where I live # Sustainable research # Clean Air (indoor and outdoor)

33 the SOLUTION - EU EU Public Health Programme Pharmaceutical Forum FP7 Strategy & Directive on Ambient Air Pollution Green Paper on Smokefree Environments Green Paper on Indoor Air Pollution

34 HANK YOU

35 Promoting cross-border exchange of best practices Daniel Mann Health Information DG SANCO: Health and Consumer Protection European Commission 35

36 Responding to the need for comparable incidence data In Europe 32 million people have asthma The mean prevalence of clinical asthma in Western Europe is 5.9%. Ref. Global Initiative for Asthma. The Global Burden of Asthma Report 2004 ( It is estimated that in the Western Europe the prevalence of asthma has doubled over the last decade. Ref. The European Lung Foundation and the European Respiratory Society. The European Lung White Book: The First Comprehensive Survey on Respiratory Health in Europe ( The total annual cost of asthma in Europe has been estimated (in the European Lung White Book 2003) at 17.7 billion euros. European Community Respiratory Health Survey International Study of Asthma and Allergies in Childhood (ISAAC) AIRE (Asthma Insights & Reality in Europe) study GA²LEN (Global Allergy and Asthma European Network

37 Responding to the need for better prevention and treatment Community actions should complement the Member States national health policies: To improve information and knowledge for the development of public health To enhance the capability of responding rapidly and in a coordinated fashion to threats to health To promote health and prevent disease through addressing health determinants across all policies and activities.

38 Public health initiatives (I) Tobacco health education measures improved consumer information and assistance restrictions on tobacco advertising and marketing mainstreaming into taxation policy and agricultural policy Legislative measures: o content, packaging and advertising of tobacco products o Green paper on environmental tobacco smoke

39 Public health initiatives (II) Indoor air quality Action Plan ( ) for the Environment and Health Strategy in June 2004, with the main objective to strengthen EU capacity for policy making coordinating environment and health policies. The Commission has asked the Scientific Committee on Health and Environment Risks (SCHER) to develop an opinion as a basis for an assessment of the risks to human health from indoor air quality. First Expert Working Group to be set up on Indoor Air Quality in November 2006 to consider specific options for action Research Coordination action (ENVIE) funded by DG Research, one of the goals of which is to set research priorities in the field of indoor air.

40 Responding to need for better treatment: Main aspects of the information strand The information strand of the EU public health programme concentrates on: Developing and defining health indicators Diffusion of the information on health on the basis of comparable methods of collection in the form of reports and analysis Improving information to the citizen and to policy makers by means of reports and internet resources Increasing the evidence base for policy making

41 Public health funded projects IMCA (Indicators for Monitoring COPD and asthma in the EU) project developed indicators to monitor asthma in the European Union described the prevalence of asthma related symptoms, asthma attacks, physician diagnosed asthma by age group, gender, socioeconomic status and geographical area ENHIS2 - Establishment Of Environmental Health Information System Supporting Policy Making Identify policy relevant information on exposure to environmental hazards, its determinants and health effects, as well as information for policy evaluation. Update the core set of environmental health indicators including those relevant for children s health. Analysis and reporting of current EH situation and policyeffectiveness assuring effective dissemination of EH information and risk communication.

42 Diffusion Project reports on Europa server and paper copies available in some cases, where possible translated into official languages Short list of Community Health indicators online and regularly updated Disease sheets available in 4 languages with links to data sources and projects Health Portal

43 Other sources DG-Research 6th Framework Programme: GA²LEN (Global Allergy and Asthma European Network) to coordinate research capacity in Europe on Allergy and Asthma issues Pharmaceutical Forum Non-statutory information to patients