Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3: Area 5)

Bousquet, J.; Farrell, J.; Crooks, G.; Hellings, P.; Bel, E. H.; Bewick, M.; Chavannes, N. H.; de Sousa, J. Correia; Cruz, A. A.; Haahtela, T.; Joos, G.; Khaltaev, N.; Malva, J.; Muraro, A.; Nogues, M.; Palkonen, S.; Pedersen, S.; Robalo-Cordeiro, C.; Samolinski, B.; Strandberg, T.; Valiulis, A.; Yorgancioglu, A.; Zuberbier, T.; Bedbrook, A.; Aberer, W.; Adachi, M.; Agusti, A.; Akdis, C. A.; Akdis, M.; Ankri, J.; Alonso, A.; Annesi-Maesano, I.; Ansotegui, I. J.; Anto, J. M.; Arnavielhe, S.; Arshad, H.; Bai, C.; Baiardini, I.; Bachert, C.; Baigenzhin, A. K.; Barbara, C.; Bateman, E. D.; Beghé, B.; Kheder, A. Ben; Bennoor, K. S.; Benson, M.; Bergmann, K. C.; Bieber, T.; Bindslev-Jensen, C.; Bjermer, L.; Blain, H.; Blasi, F.; Boner, A. L.; Bonini, M.; Bonini, S.; Bosnic-Anticevitch, S.; Boulet, L. P.; Bourret, R.; Bousquet, P. J.; Braido, F.; Briggs, A. H.; Brightling, C. E.; Brozek, J.; Buhl, R.; Burney, P. G.; Bush, A.; Caballero-Fonseca, F.; Caimmi, D.; Calderon, M. A.; Calverley, P. M.; Camargos, P. A. M.; Canonica, G. W.; Camuzat, T.; Carlsen, K. H.; Carr, W.; Carriazo, A.; Casale, T.; Cepeda Sarabia, A. M.; Chatzi, L.; Chen, Y. Z.; Chiron, R.; Chkhartishvili, E.; Chuchalin, A. G.; Chung, K. F.; Ciprandi, G.; Cirule, I.; Cox, L.; Costa, D. J.; Custovic, A.; Dahl, R.; Dahlen, S. E.; Darsow, U.; De Carlo, G.; De Blay, F.; Dedeu, T.; Deleanu, D.; De Manuel Keenoy, E.; Demoly, P.; Denburg, J. A.; Devillier, P.; Didier, A.; Dinh-Xuan, A. T.; Djukanovic, R.; Dokic, D.; Douagui, H.; Dray, G.; Dubakiene, R.; Durham, S. R.; Dykewicz, M. S.; El-Gamal, Y.; Emuzyte, R.; Fabbri, L. M.; Fletcher, M.; Fiocchi, A.; Fink Wagner, A.; Fonseca, J.; Fokkens, W. J.; Forastiere, F.; Frith, P.; Gaga, M.; Gamkrelidze, A.; Garces, J.; Garcia-Aymerich, J.; Gemicioğlu, B.; Gereda, J. E.; González Diaz, S.; Gotua, M.; Grisle, I.; Grouse, L.; Gutter, Z.; Guzmán, M. A.; Heaney, L. G.; Hellquist-Dahl, B.; Henderson, D.; Hendry, A.; Heinrich, J.; Heve, D.; Horak, F.; Hourihane, J. O’. B.; Howarth, P.; Humbert, M.; Hyland, M. E.; Illario, M.; Ivancevich, J. C.; Jardim, J. R.; Jares, E. J.; Jeandel, C.; Jenkins, C.; Johnston, S. L.; Jonquet, O.; Julge, K.; Jung, K. S.; Just, J.; Kaidashev, I.; Kaitov, M. R.; Kalayci, O.; Kalyoncu, A. F.; Keil, T.; Keith, P. K.; Klimek, L.; Koffi N’Goran, B.; Kolek, V.; Koppelman, G. H.; Kowalski, M. L.; Kull, I.; Kuna, P.; Kvedariene, V.; Lambrecht, B.; Lau, S.; Larenas-Linnemann, D.; Laune, D.; Le, L. T. T.; Lieberman, P.; Lipworth, B.; Li, J.; Lodrup Carlsen, K.; Louis, R.; MacNee, W.; Magard, Y.; Magnan, A.; Mahboub, B.; Mair, A.; Majer, I.; Makela, M. J.; Manning, P.; Mara, S.; Marshall, G. D.; Masjedi, M. R.; Matignon, P.; Maurer, M.; Mavale-Manuel, S.; Melén, E.; Melo-Gomes, E.; Meltzer, E. O.; Menzies-Gow, A.; Merk, H.; Michel, J. P.; Miculinic, N.; Mihaltan, F.; Milenkovic, B.; Mohammad, G. M. Y.; Molimard, M.; Momas, I.; Montilla-Santana, A.; Morais-Almeida, M.; Morgan, M.; Mösges, R.; Mullol, J.; Nafti, S.; Namazova-Baranova, L.; Naclerio, R.; Neou, A.; Neffen, H.; Nekam, K.; Niggemann, B.; Ninot, G.; Nyembue, T. D.; O’Hehir, R. E.; Ohta, K.; Okamoto, Y.; Okubo, K.; Ouedraogo, S.; Paggiaro, P.; Pali-Schöll, I.; Panzner, P.; Papadopoulos, N.; Papi, A.; Park, H. S.; Passalacqua, G.; Pavord, I.; Pawankar, R.; Pengelly, R.; Pfaar, O.; Picard, R.; Pigearias, B.; Pin, I.; Plavec, D.; Poethig, D.; Pohl, W.; Popov, T. A.; Portejoie, F.; Potter, P.; Postma, D.; Price, D.; Rabe, K. F.; Raciborski, F.; Radier Pontal, F.; Repka-Ramirez, S.; Reitamo, S.; Rennard, S.; Rodenas, F.; Roberts, J.; Roca, J.; Rodriguez Mañas, L.; Rolland, C.; Roman Rodriguez, M.; Romano, A.; Rosado-Pinto, J.; Rosario, N.; Rosenwasser, L.; Rottem, M.; Ryan, D.; Sanchez-Borges, M.; Scadding, G. K.; Schunemann, H. J.; Serrano, E.; Schmid-Grendelmeier, P.; Schulz, H.; Sheikh, A.; Shields, M.; Siafakas, N.; Sibille, Y.; Similowski, T.; Simons, F. E. R.; Sisul, J. C.; Skrindo, I.; Smit, H. A.; Solé, D.; Sooronbaev, T.; Spranger, O.; Stelmach, R.; Sterk, P. J.; Sunyer, J.; Thijs, C.; To, T.; Todo-Bom, A.; Triggiani, M.; Valenta, R.; Valero, A. L.; Valia, E.; Valovirta, E.; Van Ganse, E.; van Hage, M.; Vandenplas, O.; Vasankari, T.; Vellas, B.; Vestbo, J.; Vezzani, G.; Vichyanond, P.; Viegi, G.; Vogelmeier, C.; Vontetsianos, T.; Wagenmann, M.; Wallaert, B.; Walker, S.; Wang, D. Y.; Wahn, U.; Wickman, M.; Williams, D. M.; Williams, S.; Wright, J.; Yawn, B. P.; Yiallouros, P. K.; Yusuf, O. M.; Zaidi, A.; Zar, H. J.; Zernotti, M. E.; Zhang, L.; Zhong, N.; Zidarn, M.; Mercier, J.

doi:10.1186/s13601-016-0116-9

Table 6 Classification of good practices for replication: the example of the Finnish Asthma Plan [40]

From: Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3: Area 5)

Items		Example of the Finnish Asthma Plan
Knowledge—gaps	Between knowledge and practice (research, specific)	The plan has been [69] tested and validated at the national level [40]
	Existence of tested solutions (good examples, specific)	It has shown cost-effective reduction of hospitalisations, deaths and disability
	Large variations between countries (good examples, general)	The Finnish Asthma Plan has been deployed successfully to over 25 countries globally including developing countries. The same effectiveness has been demonstrated [70, 71]. The Finnish Asthma Plan is considered to be the model of all asthma plans in the world [35]
Reaction time	Calendar (time needed for implementation	The Finnish Asthma Plan was a 10-year plan. Most indicators were found to change significantly after 24–36 months, but the effectiveness improved over the 10-year programme. In Brazil, an impact at population morbidity indicators was found after 24 months
Reaction time	Effects/visibility (time needed to assess impact)
Stewardship	Administrative and political capacity. Leadership, inside the health sector and in other sectors (Health in All Policies)	Many plans are national plans supported by the Ministry of Health or the department of health of the region (e.g. Minas Gerais, Brazil). All stakeholders including health (specialists, GPs, nurses, pharmacists, other health care professionals) and social carers as well as patients are involved in the plan. A specific action is devoted to education, coaching and training
Political agenda	Electoral programme
	Social concerns	A specific attention has been put on social concerns and a promotion in the country at all levels (citizens and patients, health and social carers, politicians) has been continuously monitored
	Crisis
	International institutions recommendations/conditions	The Finnish Asthma Plan and its follow up (the Finnish Allergy Programme) [41, 72] has been endorsed by the Finnish Ministry of Health. Some plans in developed and developing countries (globally) are also under the Ministry of Health leadership and some have been endorsed by WHO GARD (GARD demonstration project). The Finnish Asthma Plan is listed in asthma guidelines
Costs and affordability	It is important to consider the cost of the programme for selecting priority areas for investment. Certain decisions could need relevant investments (e.g. equipment, personnel, etc.) while others involve low direct economic cost (e.g. anti-tobacco strategies and legislation). The costs of a programme have to be considered in the context of the economic situation of the country (GDP/inhabitant; expansion/recession/stagnation; private and public debt; etc.)	The Finnish Asthma Plan is comprehensive and includes treatments, preventive measures (e.g. tobacco smoking), action plans, education at all levels. It was found to be cost-effective. This has been demonstrated in Finland, but also in other countries such as Brazil [42, 73, 74]. Thus, reducing the asthma burden is cost-effective in countries with different GDP/inhabitant, health and economic systems
Acceptability	The support or the opposition that a certain policy is going to attract	The Plan was extremely well accepted in all countries where it was promoted [42]
Monitoring capability	The availability of the necessary information to monitor the starting point, the processes and the outcomes	Baseline information on the burden of asthma is available even though in most developing countries there is no information [75]. Information on the success of the programme was easily documented [35, 70, 71] and carefully monitored
Monitoring capability	It highlights also the importance of transparency	National (or regional) statistics are transparent
Contextual factors	Demographics	The Finnish Asthma Plan was a national plan covering the entire country. Some plans are regional plans (Bahia or Minais Gerais)
	Social and economic conditions	The Finnish Asthma Plan targeted the entire country. The Minais Gerais plan targets children in deprived areas (“favelas”) who are at high risk of severe exacerbations and death [76] as does the severe asthma programme established in Bahia, dealing with children and adults [70]
	Cultural factors	In Finland, barriers are not very important. However, in many developing countries, cultural barriers have been carefully considered according to a WHO report [6]. They include culture, gender issues, socio-economic inequalities, health care access, access to essential medications and techniques
	Other non-health care determinants of health that impact on population health and wellbeing

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