General practitioner-delivered adherence counseling in asthma: feasibility and usefulness of skills, training and support tools

<p><i>Objective</i>: Poor medication adherence contributes to uncontrolled asthma in primary care. Good doctor-patient communication around adherence increases patients’ medication taking but general practitioners (GPs) often feel poorly equipped to provide effective adherence counseling. This study aimed to assess the feasibility and usefulness of adherence counseling training, skills and support tools for GPs. <i>Methods</i>: Twenty-five GPs enrolled in a 6-month cluster randomized-controlled trial of adherence interventions for asthma were randomized to an intervention delivering personalized adherence discussions. They received 2 hours training in delivering brief, motivational-interviewing-based adherence counseling and were provided with asthma-specific counseling support tools. At baseline, post-training and study end, GPs rated the training, reported confidence/frequency of using counseling skills and satisfaction with their consultations, and commented on support tools. Patients reported their barriers to adherence and rated their GPs empathy at baseline and at 6-months. <i>Results</i>: 96% of GPs rated adherence counseling training as very/extremely useful. At the end of the study (17 ± 4 months) GPs’ confidence in using counseling skills increased, as did the frequency they applied the skills and their satisfaction with consultations. GPs were positive about counseling support tools, stating that they were easy to use and facilitated covering more ground within single consultations. Half the GPs expressed some difficulty implementing counseling due to time constraints. Patients reported good GP empathy and no significant change in adherence barriers. <i>Conclusions</i>: GPs valued counseling training and support tools. Although implementation was sometimes challenging, GPs reported increased frequency of use and confidence in applying adherence counseling skills, which persisted for 17 months.</p

Molecular approaches for improved biological control of plant diseases

Summary: Environmental and consumer concerns and subsequent protective legislation have focused scientific interest on the development of microbial inoculants as environmentally acceptable methods of replacing or decreasing the use of chemical pesticides for crop protection. While potential bioccontrol agents have been identified among fungal, actinomycete and bacterial species, molecular biology techniques are being increasingly employed to enhance the efficacy of these natural isolates. Such techniques include the development improved inoculants capable of enhanced biocontrol metabolite production or with the ability to synthesise combinations of these metabolites. The exploitation of microbial inoculants as effective biocontrol agents involves the introduction of large numbers of microorganisms in to the soil environment. Ensuring that these procedures are compatible with sustainable, economically viable and environmentally friendly agricultural practice has involved monitoring and assessing the impact of microbial inoculants on phytopathogens and indigenous beneficial microflora