Our two social movements for change, Asthma Right Care and COPD Right Care, aim to gain commitment to change by triggering more conversations about asthma and COPD using games and conversation pieces.
We know that the two biggest contributions of primary care to climate warming are prescribing, including of inhaled medicines, and travel.
Emeritus Professor Amanda Barnard is currently President of the International Primary Care Respiratory Group (IPCRG). An academic GP, she has recently retired as inaugural founder and head of the Rural Clinical School at the Australian National University. She has a long interest in respiratory care in general practice, and chaired the Australian Asthma Handbook Guidelines Committee for over 10 years. She is currently a board member of the National Asthma Council (Australia). She has been involved with WONCA for over 20 years, particularly with the WONCA Working Party on Women and Family Medicine (WWPWFM) which she chaired for a number of years. Amanda also serves on a number national bodies with medical education, GP training, rural workforce and health system briefs.
Amanda, congratulations on your new post as International Primary Care Respiratory Group (IPCRG) President, and thank you for speaking with us. We would like you to answer the following questions:
1. What should WONCA Europe (WE) members know about IPCRG – a WE Special Interest Group (SIG)?
IPCRG is a longstanding and active SIG. We were set up as a charity registered in Scotland in 2000, with a strong European membership. Our office team is European, but we have member countries not only in Europe but also in all WONCA regions, which explains how I can be President of a WE SIG as a GP in Australia. We represent primary care on the WHO-convened network Global Alliance against chronic Respiratory Diseases (GARD). We are also in Collaborative Relations with WONCA World. Our membership covers low-, middle- and high-income countries.
2. What are your objectives for your mandate?
I am reminded of the words of Past President Professor Ioanna Tsiligianni, who, when discussing why we get involved with additional activities on top of our other work, said to me: “IPCRG gets things done”. Reflecting on the years since that conversation, IPCRG certainly does get things done, and its rich and diverse activities continue to increase in both range and geographical spread. My objectives are to continue that work and further expand international awareness of our innovative education programs, extensive resources and research, and further mobilize our membership to reach even more primary care practitioners so we can improve prevention, diagnosis and care of respiratory disease in global community and primary care settings. I am particularly keen that IPCRG supports new member countries, when keen and dedicated doctors are working in sometimes challenging situations, to improve respiratory care in the community. In my term of office, these will be Tunisia and the North Africa region, noting our 2026 World Conference will be in Tunisia.
On another note, I have always been a champion of gender equity, having Chaired the WONCA Working Party on Women and Family Medicine (WWPWFM) from 2009-12 and been on the executive until this year. We know that gender affects both expression of respiratory disease and all the factors involved in diagnosis and management. IPCRG has developed resources on this – Desktop Helpers 1 and 8 - and during my term I want to focus a gender lens on our education and research work.
3. What are the relations of IPCRG – a WE Special Interest Group (SIG) with WE networks and other WE Special Interest Groups?
IPCRG has close relationships with several networks. Our education strategy and our flagship Teach the Teacher program to build primary care teaching capacity and content knowledge was influenced by EURACT's framework paper on continuing development of trainers. We have involved EURACT members as faculty. We regard the inequity of scope of practice, reimbursement and responsibility for diagnosing and managing chronic respiratory diseases across our members in Europe to be an issue of quality and safety and have discussed this with EQuiP. We co-promote research opportunities with EGPRN.
4. IPCRG held its 12th World Conference in Athens, Greece, from 9-11 May 2024. Its theme was “Creating Change”. What were its key messages?
We opened with two speakers, EQuiP’s Andrée Rochfort and Mayara Floss, a young Brazilian GP active in Rural WONCA talking about the need for primary care to adapt the consultation to incorporate planetary health guidance, and in a workshop explored how GPs can role model different ways of engaging the community on planetary health. We gave substantial airtime to our social movements for change - Asthma Right Care and COPD Right Care. 160 abstracts were presented, many showing how to implement improvements in chronic respiratory disease care globally. Finally, we invested in two programs - a leadership program and Spirometry Simplified to address the need for future leaders in CRD and also improved confidence and competence to diagnose them - this is acknowledged as a gap by WHO.
5. IPCRG attended WONCA Europe 2024 Conference (25-28 September in Dublin, Ireland). What were its contributions?
IPCRG ran two successful workshops at the WONCA Europe 2024 conference. One was a practical workshop on breathlessness management that was very well received. The focus was on managing the symptom during and after diagnosing the underlying cause(s) using simple, affordable evidence-based interventions. Read more here. The other workshop was on the challenge of asthma diagnosis using a jigsaw analogy as a way of thinking about how patients present in general practice over time, with varying symptoms and concerns, in a non-linear fashion, and how to build a picture - asking what fits and what doesn’t - to reach a diagnosis of asthma.
We also presented our conceptual approach to asthma diagnosis, using the metaphor of building a puzzle over time, which has been well received by educators.
6. What is npjPrimary Care Respiratory Medicine?
Our peer reviewed journal, in Q1 of primary care journals with a focus on diagnosis, risk factor, symptom and disease management related to respiratory health globally. https://www.nature.com/npjpcrm/
7. What are Asthma Right Care and COPD Right Care?
Our two social movements for change, Asthma Right Care and COPD Right Care, aim to gain commitment to change by triggering more conversations about asthma and COPD, using games and conversation pieces such as slide rules, wheels and Question & Challenge Cards. They firstly may increase “conscious incompetence”, but then go on to reassure and work with people to build confidence and competence to deliver good quality care: the right interventions at the right time by the right health worker, based on the patient needs, preferences and values. Asthma Right Care is now active in over 20 countries and our European colleagues are very creative, energetic and committed. For example, our Portuguese group has developed an asthma e-escape room and organized community walks and talks on buses; our Spanish team has developed game shows; our UK group has developed the slide rule idea further, and North Macedonia has been rolling out an Asthma Right Care Teach the Teacher program involving GPs and pharmacists. Find videos, how to guides and materials by clicking the links above.
8. IPCRG is very worried about climate change. What do you think GPs should do about it?
We know that the two biggest contributions of primary care to climate warming are prescribing, including of inhaled medicines, and travel. Therefore, we want GPs to green the respiratory pathway by reducing misuse of inhalers such as over-reliance on short-acting beta agonists as monotherapy for asthma but also ensuring when switching people to other inhalers that they can use them, and not create further waste. Tobacco’s impact on the environment means we should also support the health promotion role of GPs, particularly of their own staff and families at risk of tobacco dependence (children are more likely to smoke if their parents do). In Europe, tobacco dependence is the main cause of COPD so we need GPs to actively help people quit (here's our position paper agreed with WONCA Europe) given Very Brief Advice (VBA)’s proven effectiveness, demand more on tobacco in undergraduate curricula and better access to pharmacotherapy. We can also invite GPs and pharmacists to be antibiotic guardians. See here https://www.ipcrg.org/aboutus/advocacy/ipcrg-and-climate-change.
9. You are very active promoting e-learning programs? Could you tell us about it?
For IPCRG, like many organizations, COVID forced a switch to online and a subsequent reconsideration of how best we can reach people globally, and minimizing travel and its attendant problems. We developed an evidence-based question and answer program during COVID and then translated that into case-based e-learning on COVID and asthma and COPD. We achieved high completion rates due to its appropriateness. Most exciting is a new e-learning program called Spirometry Simplified which draws on the European standards, primary care teaching experience and new thinking on e-learning to create a four module program that has been very well received. There is a masterclass that can be tailored to teaching, interpreting and/or doing spirometry, an assessed portfolio and mentoring. We are very proud of its quality and hope we can promote it. Do approach us if you want to set up something in your country.
In addition, we have begun producing digital material for GPs to share with their patients to support self-management. Following an innovative YouTube search strategy rather than PubMed we have curated ‘how to’ videos for people with COPD: www.ipcrg.org/copdmagazine. These are in multiple languages.
10. What do you think will be the impact of Artificial Intelligence (AI) and Machine learning on Primary Care Respiratory Medicine in the next few years?
There is definitely scope to improve the consistency of diagnosis and to tailor management for allergic rhinitis, asthma and COPD to the individual. AI may also help with generation/curation of tailored individual advice and resources. A major role in research could be collection of real-life patient data and experiences and relevant outcomes in general practice. However, at the core, we must protect and improve consultation skills to ensure we know what the patient needs and wants.
11. Which book are you reading now? Do you recommend it?
I have just finished a book called ‘Rapture’ by the Australian author Emily Maguire. It is an extraordinary tale of a young woman in 9th century Europe who lives in the disguise of a Benedictine monk to devote herself to the study which is denied to her as a woman. She becomes a celebrated scholar and high-ranking church official - but of course there is more to the plot with love, political intrigue and an unexpected ending. I would recommend it – it was my sole entertainment on the flight home from Dublin, I didn’t even look at the movie choice!
Thanks for taking the time to talk to us and answer our questions.