Transcript Global Asthma Physician and Patient (GAPP) Survey

Global Asthma Physician
and Patient (GAPP) Survey
Key Global Pediatric Findings
GAPP Survey Contents
• Key Global Findings
• Objectives and Overview
• Methodology
• Global Pediatric Findings
– Physician-parent-patient communication gaps
– Factors affecting compliance
– Need for new treatments
• Conclusions and Implications
GAPP Survey
Global Key Findings
GAPP Survey: Global Key Findings
Patient compliance and outcomes may be enhanced by:
Better physician/parent/patient
communication and asthma education
Education
New treatment options with lower
side effect profiles
Compliance
•Asthma education is
insufficient and inadequate
•Treatment non-compliance
decreases quality of life and
increases resource utilization
•Parents may not understand
that asthma is a serious
disease that they need to
continually manage
•Experience and concern
about the potential for side
effects were patients’ primary
reasons for non-compliance
•Physician and parents/patient
communication needs to
improve in order to increase
understanding of asthma
management
•Parents who report having
more discussions with their
physicians about techniques
for successful asthma
management report greater
treatment compliance
Treatment
• Physicians and
parents/patients agree there
is a need for new ICS
treatments with an
improved safety profile
GAPP Survey
Overview
GAPP Survey: Overview
A large-scale global survey
was conducted with physicians and
parents of patients with asthma to build
on the existing body of research
regarding asthma attitudes and
treatment practices
GAPP Survey Objectives
• Enhance understanding and awareness of
likely contributors to suboptimal asthma
management
• Explore content and dynamics of physicianparent/patient communications
• Ultimately enhance treatment compliance and
outcomes
The GAPP Survey is Unique
• The GAPP Survey was designed to uncover
asthma attitudes and treatment practices
among physicians and parents/patients, with
the goal of identifying barriers to optimal
management
• First-ever global quantitative survey to:
– Examine the same themes in parents/patients and
physicians
– Ask similar questions to both parents and physicians
GAPP Survey
Background
The Seriousness of Asthma
Despite advances in asthma management, many
patients still experience:
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Asthma exacerbations including acute attacks
Frequent symptoms
Unscheduled and increased doctor visits
Emergency room visits and hospitalizations
Mortality1,2
Missed lifestyle and social effects
Economic burden
1. GINA Asthma Fact Sheet: “What is Asthma?” Available at: http://207.159.65.33/wadsetup/materials_04/asthma04.doc.
2. GINA “Global Strategy for Asthma: Global Strategy for Asthma Management and Prevention,” 1995. Available at:
http://www.iaqoc.com/library/workshop.pdf.
Previous Asthma Research
• Asthma Insights and Reality (AIR) studies described the
current state of patient knowledge, attitudes and behavior
towards asthma1:
– Patients underestimate the severity of their disease; asthma practice
falling short of treatment guidelines
– Patients do not understand how asthma is caused or how it is treated
• Findings suggested need to:
– Improve physician and patient expectations of asthma treatment
– Increase awareness of anti-inflammatory agents
• AIR studies raised even more questions about
patient/physician disconnect regarding side-effects,
treatment regimens and communication
Unanswered Questions from AIR led to Development of the GAPP Survey
1. Rabe KF, et. al. J Allergy Clin Immunol. 2004 Jul;114(1):40-7.
GAPP Survey Advisory Board
• Comprised of professional organizations:
– The World Allergy Organization (WAO)
– The American College of Allergy, Asthma & Immunology
(ACAAI)
GAPP Survey Working Group
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Carlos E. Baena-Cagnani
– Catholic University of Córdoba, Córdoba, Argentina, for WAO
Michael S. Blaiss
– University of Tennessee Health Science Center, Memphis, TN, USA, for
ACAAI
G. Walter Canonica
– University of Genova DIMI, Genova, Italy, for WAO
Ronald Dahl
– Aarhus University Hospital, Department of Respiratory Diseases, Aarhus,
Denmark, for WAO
– Past-President of the European Respiratory Society (ERS)
Michael A. Kaliner
– Institute for Asthma & Allergy, Chevy Chase, MD, USA, for WAO
– President of the World Allergy Organization
Erkka J. Valovirta
– Turku Allergy Center, Turku, Finland, for WAO
– Past-President of European Federation of Allergy and Airways Diseases
Patients Associations (EFA)
GAPP Survey
Methodology
GAPP Survey : Population
Global adult research
Global pediatric research
UK asthma nurses
GAPP Survey: Pediatric Survey
9 Countries:
– Asia: Japan
– Europe: France, Germany, Italy, Spain,
Switzerland, the United Kingdom
– North America: Canada, the United States of
America
GAPP Survey: Methodology
• Harris Interactive conducted the research on
behalf of the GAPP Survey global advisory
board
– A prominent global survey company with a
specialized healthcare market research
department
– Recruiting was accomplished via:
– Harris Interactive’s online panel
– Physician referrals
– Existing sample lists
– 20-minute close-ended questionnaires
GAPP Survey: Methodology
Harris Interactive conducted the survey on behalf of the
GAPP Survey Advisory Board
Conducting the
Survey
• Online, telephone
and face-to-face
interviews
• 18 May through 24
August 2005
Sample Sizes
Criteria
• Each country
surveyed about 100
each for parents and
physicians
•Physicians currently
practicing medicine for
3-30 years, sees ≥ 3
pediatric patients with
asthma /week and
writes ≥ 1 prescription
for asthma
medications /week
• In the U.S., where the
sample sizes were
about 200 for each
group (only data
weighted)
•Parents of children
diagnosed with
asthma
GAPP Survey: Interviews
5482 physician and parent/patient
interviews conducted worldwide
Pediatric
• 1017
• 1006 physicians who treat children with
GAPP Survey
parents of
asthma
children
– 230 generalists (family practitioners, general
practitioners and internal medicine
diagnosed
practitioners)
with asthma
– 776 pediatricians
Adult GAPP
Survey
• 1726 adults • 1733 physicians who treat adults:
with asthma
– 916 generalists
(family, general and internal medicine
age ≥ 18
practitioners)
years
– 817 specialists
(allergists, pulmonologists, respirologists)
GAPP Survey Global
Pediatric Findings
GAPP Survey: Pediatric Arm
2023 physician and parents of children with asthma
were interviewed worldwide
PARENTS
PHYSICIANS
1017 parents of children
diagnosed with asthma
•Recruiting was
accomplished via: Harris
Interactive’s online panel,
physician referrals and
existing sample lists
1006 physicians who treat
children with asthma:
•230 generalists (family,
general and internal
medicine practitioners)
•776 pediatricians
Pediatric Asthma Treated Mostly by
Pediatricians
Pediatrician
45%
PCP
31%
Not Seeing
Anyone
2%
Nurse
3%
Specialist
19%
Other Type of
Physician
1%
Which type of doctor or healthcare professional does your child usually see to treat his or her asthma?
Base: All Respondents (Parents)
A Majority of Parents Perceive their
Child’s Asthma as Mild
Severe
9%
Mild
51%
Moderate
40%
Overall, based on your child’s symptoms, how would you describe his or her asthma?
Base: All Respondents (Parents)
Resource Utilization in the Past 12
Months Indicates Poor Patient Asthma
Control
50%
41%
36%
40%
30%
15%
20%
8%
10%
0%
Made
unscheduled
visits to doctor
Made
unscheduled
calls to doctor
Went to hospital
ER
During the past 12 months, have you… because of your asthma? Base: All Respondents (Parents)
Admitted to
hospital
According to Parents
Asthma Limits Patients’ Daily Activities
Not at All
22%
A Great
Deal
8%
Somewhat
34%
Not Much
36%
Overall, how much has your child’s asthma limited his or her ability to do daily activities?
Base: All Respondents (Parents)
42% have
limited
daily
activities
GAPP Survey
Disconnect between
parents and physicians
on factors affecting
compliance
Disconnect Found Between
Parent-Reported Compliance & PhysicianPerceived Pediatric Patient Compliance
Parents Report
Incidence Reported (%)
100
Physicians
80
59%
56%
60
40
25%
10%
20
14%
15%
9%
9%
2%
0
0%
0%
of the time
1-50%
of the time
51-80%
of the time
81-99%
of the time
What percentage of the time do or did your child take his or her asthma medication according to his or her doctor or other health care
professional’s instructions? Base: Currently or Has Ever Taken Asthma Medications (Parents)
What percentage of the time does your average pediatric asthma patient take his or her medication according to your instructions? Base:
All Respondents (Pediatric Physicians)
100%
of the time
Parents and Physicians Disagree on Content
of Education Provided and Received
Correct inhaler
technique
82%
95%
Develop individual
management plan
65%
85%
Monitor peak
expiratory flow
51%
71%
Keep daily symptom/
medication diaries
33%
57%
Contact patient
support organizations
Parents Report
Physicians
15%
36%
0
50
100
Incident Reported (%)
Does your child’s doctor or other healthcare professional in his or her office discuss any of the following with you or your child? Base: All Respondents (Parents)
Do you regularly discuss the following with your pediatric asthma patients or their parents? Base: All Respondents (Pediatric Physicians)
Almost Half of Parents are Unaware or do
not Believe that Asthma can be Fatal in
Patients with Mild Asthma
False: 24%
True: 51%
49% are
unaware
Not sure:
25%
Is the following statement true or false or are you not sure? Asthma attacks can be fatal in patients with mild asthma.
Base: All Respondents (Parents)
Treatment Compliance Increases with
Increased Parent/Patient Education
Parent/Patient Treatment Compliance
< 51%
compliant
Amount of time spent
on patient education
23%
51-80%
compliant
81-99%
compliant
100%
compliant
35%
36%
40%
Increase in Compliance (%)
Physicians and Patients Disagree on Who
Starts the Discussion on Side Effects
Physicians
Patients
2% do not discuss
side effects
41%
Doctor
Or healthcare
provider
29%
Parent
or child
59%
Me or my
child
When you discuss or discussed side effects of asthma medications with your child’s doctor or other health care
professional, who typically brings up the topic, you or your child, or your child’s doctor or health care provider?
Base: Always, Sometimes or Rarely Discusses Short or Long Term Side Effects (Parents)
When you discuss side effects of asthma medications, who typically brings up the topic, you or your patient or their
parent – or you don't discuss side effects?
Base: All Respondents (Pediatric Physicians)
69%
Me
Parents’ Lack Awareness of Potential ICS
Side Effects
Parents and Physicians Differ in Opinion
Decreased
production
of cortisol
Long-term
side effects*
39%
21%
27%
8%
Parents Report
Short-term
side effects**
14%
Physicians
5%
0
10
20
30
40
50
% of Parents Who Were Not Aware of Side Effects
% of Physicians Stating Their Patients Were Not Aware of Side Effects
*Such as weight gain, weakening of the bones or changing bone density, or cataracts
** Such as such as fungal infection, sore throat or hoarseness
On a scale of 1 – 10 where “1” means “not at all concerned” and “10” means “extremely concerned,” how concerned have you been with the following potential side
effects or, were you not previously aware of these as potential side effects for your child? Base: All Respondents (Parents)
On a scale of 1 – 10 where “1” means “not at all concerned” and “10” means “extremely concerned,” how concerned are your patients or their parents with each of the
following potential side effects of inhaled corticosteroids, or are they not aware of potential side effects?
Base: Prescribes Inhaled Corticosteroids (Pediatric Physicians)
Reasons Patients Switched/Discontinued
Asthma Medications
Side Effects Lead to Parents/Patients Switching or Discontinuing Treatment
Incidence Reported (%)
50
40
39%
30
18%
20
12%
11%
6%
10
0
Symptoms
went away
or lessened
Experienced
side effects
Concerned
about
potential
side effects
Medication
was too
expensive
Inconvenient
to use
Since being diagnosed with asthma, has your child ever switched from one asthma medication to another or
discontinued an asthma medication because…? Base: Currently or Has Ever Used Asthma Medication (Parents)
Significant Numbers of Pediatric Patients
with Asthma Experience Side Effects (SEs)
Incidence Reported (%)
50
40
30
26%
20
10%
10
0
Short-term
SEs
While taking asthma medications, has your child ever experienced …?
Base: Child Currently or Has Ever Taken Asthma Medication (Parents)
Long-term
SEs
Side Effects Contribute to Treatment
Non-Compliance
Of patients who have experienced side effects, SEs have caused them to:
Incidence Reported (%)
50
40
33%
33%
30%
28%
30
15%
20
10
0
Consider
switch
medications
Consider
skipping
doses
Skip
doses
Change
dosage
Stop taking
medications
Have any of the asthma medication side effects you experienced since being diagnosed caused you or your child to…?
Base: Experienced at Least One Side Effect of Asthma Medications (Parents)
Treatment Non-Compliance Decreases
Quality of Life
66%
Increased symptoms
48%
Limited physical activity
46%
Nocturnal waking
More frequent attacks/
exacerbations
Increased
Bronchodilator use
Less interaction with
family/friends
Life-threatening attacks
40%
34%
21%
9%
0
10
20
30
40
50
60
70
Incidence Reported (%)
Has your child ever experienced the following if he or she doesn’t or didn’t take his or her asthma medication as instructed?
Base: Child Takes or Took Asthma Medication Less Than 100% of the Time (Parents)
Treatment Non-Compliance Increases
Resource Utilization
More physician visits
38%
More hospitalizations/
ER visits
14%
0
10
20
30
40
50
60
Incidence Reported (%)
Has your child ever experienced the following if he or she doesn’t or didn’t take his or her asthma medication as instructed?
Base: Child Takes or Took Asthma Medication Less Than 100% of the Time (Parents)
70
Consequences of Non-Compliance:
Increased Resource Utilization
• The number of disability-adjusted life years (DALYs) lost
due to asthma worldwide has been estimated to be
currently about 15 million per year
– Asthma was the 25th leading cause of DALYs lost
worldwide in 20011
• World-wide, the economic costs associated with asthma
are estimated to exceed those of TB and HIV/AIDS
combined2
1. GINA “Global Burden of Asthma,” 2004. Available at: http://www.ginasthma.com/ReportItem.asp?l1=2&l2=2&intId=94.
2. WHO http://www.who.int/mediacentre/factsheets/fs206/en/
Side Effects Contribute to Diminished
Quality of Life & Increased Resource Utilization
Impaired
Quality of Life
and Resource
Utilization
Side-effects
Poor compliance
GAPP Survey
Physicians and
Parents/Patients Assess
Need for New Asthma
Treatment Options
Incidence Reported (%)
Physicians Agree: Inhaled Corticosteroids
are First-Line Therapy
100
92%
98%
80
60
53%
78%
40
20
Strongly Agree
39%
20%
0
Inhaled corticosteroids (ICS)
are the “gold standard”
treatment for asthma
In treating asthma, if you
treat the inflammation, you
reduce the risk of
broncho-constriction
Please indicate whether you agree strongly, agree somewhat, disagree somewhat or disagree strongly with the
following statements. Base: All Respondents (Pediatric Physicians)
Somewhat Agree
First-Line Treatment Used By Physician;
Not Following GINA Guidelines
96%
89%
Generalist
52%
43%
Mild
Intermittent
91%
77%
71%
26% 23%
47%
49% 46%
37%
85% 85%
65% 62%
92%
73%
83%
79%
47%
73% 81%
55%
Moderate
Persistent
85%
37% 37%
82% 81%
Mild
Persistent
89%
25% 20%
Pediatrician
87% 92%
68%
68%
58%
70%
80%
Severe
Persistent
SABA
ICS
LABA
Combi
Which medication or medications do you prescribe as first-line treatment for mild intermittent, mild persistent, moderate
persistent and severe persistent asthma in your pediatric patients? Base: All Respondents (Pediatric Physicians)
LTRA
Highlight: Physicians are not Following GINA
Guidelines for Treatment of Pediatric Patients
with Mild Persistent Asthma
96%
89%
Generalist
52%
43%
Mild
Intermittent
Low-dose
inhaled
91%
82% 81%
77%
corticosteroid is
Mild
Persistent recommended
89%
71%
25% 20%
26% 23%
47%
49% 46%
37%
85% 85%
65% 62%
92%
73%
83%
79%
37% 37%
47%
73% 81%
55%
Moderate
Persistent
85%
Pediatrician
87% 92%
68%
68%
58%
70%
80%
Severe
Persistent
SABA
ICS
LABA
Combi
Which medication or medications do you prescribe as first-line treatment for mild intermittent, mild persistent, moderate
persistent and severe persistent asthma in your pediatric patients? Base: All Respondents (Pediatric Physicians)
LTRA
USA Food and Drug Administration (FDA) and the
UK’s Medicines and Healthcare products Regulatory
Agency (MHRA) LABA Warning
Global Initiative for Asthma (GINA) guidelines low-dose glucocorticosteroids mono-therapy is the
recommended medication for children with mild persistent asthma
•
The SMART trial, addressed emerging safety issues concerning salmeterol (LABA). Thirteen
patients taking salmeterol suffered asthma-related deaths compared to the three asthma-related
deaths involving patients taking the placebo.
– The FDA and the MHRA announced a warning that LABA treatments should not be used for
first-line treatment, and LABAs should be added to the asthma treatment plan only if other
medicines do not control asthma, including the use of low-or-medium dose corticosteroids.1,
2
•
First-line treatment physicians are using for their pediatric mild persistent patients (based on
GAPP Findings)
– 41% of physicians are prescribing long acting beta-agonists (LABA)
– 48% are prescribing fixed combination medications (ICS + LABA)
1. United States Food and Drug Administration. “Long Acting Beta Agonists Advisory.” November 2005.
Available at http://www.fda.gov/cder/drug/infopage/LABA/default.htm. Accessed February 7, 2006.
2. Medicines and Healthcare products Regulatory Agency. Safety information for long acting beta agonists. Available at
http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary=true&ssDocName=CON2022601&ssTargetNodeId=221.
Accessed February 7, 2006.
Physicians and Parents Agree: Need for
Improved Asthma Treatment Options
100
84%
% Reported
80
80%
Parents Report
Physicians
60
40
20
0
Think There is a Need for New Treatments
Physicians who believe there should be more treatment options are
less satisfied with side effect profiles of existing treatments
Do you think there is a need for new medication options for children with asthma? Base: All Respondents (Parents)
Do you believe there are still unmet needs in the area of inhaled corticosteroid therapy?
Base: All Respondents (Pediatric Physicians)
ICS Key Attributes: Physician Are Least
Satisfied with Side Effects
Extremely
satisfied
10
9
8
8.1
7.9
7.5
7.4
7.1
7
6.8
6
5
4
3
2
Extremely
dissatisfied
1
Efficacy Availability in Frequency Convenience Systemic
Local
Combination of Dosing
Side Effects Side Effects
with LABA
On a scale of 1 – 10 where “1” means “extremely dissatisfied” and “10” means “extremely satisfied,” how satisfied are
you with the following features of available inhaled corticosteroids?
Base: All Respondents (Pediatric Physicians)
Key Attribute of Current Therapies: Parents Are
Least Satisfied with Side Effects
Reported Level of Satisfaction ( %)
100
91%
92%
89%
85%
85%
80
72%
60
40
20
0
Ease of
Use
Effectiveness
Fast
Acting
How
Many
Times a
Day
Safety
Overall, how satisfied or dissatisfied are you with the following features of your current asthma medication or
medications? Base: Currently Taking Asthma Medication (Patients)
Potential
for Side
Effects
Need for a New Treatment
PARENTS
• 80% of parents believe
there is a need for new
medication options
• Those who have been
more affected by their
disease, were more likely
to believe there is a need
for a new treatment
PHYSICIANS
• 84% of physicians
believe there are still
unmet needs in the area
of ICS therapy
• Physicians report that a
new ICS therapy with
comparable efficacy and
an improved safety and
tolerability profile is
needed
Conclusions and Implications
Asthma education is insufficient and inadequate; there is a
disconnect between physician-parent/patient communication
Side effects and fear of side effects reduce compliance
with treatment, decreasing quality of life
and increasing resource utilization
Parent/patient compliance and outcomes may be improved by:
Better physician/patient communication and asthma education
New treatment options with lower side effect profiles
Parents and physicians are looking for
improved asthma treatments