Abstract
BackgroundDespite effective treatments and long-standing management guidelines, there are approximately 1400 hospital admissions for asthma weekly in the United Kingdom (UK), many of which could be avoided. In our previous research, a secondary analysis of the intervention (ARRISA) suggested an improvement in the management of at-risk asthma patients in primary care. ARRISA involved identifying individuals at risk of adverse asthma events, flagging their electronic health records, training practice staff to develop and implement practice-wide processes of care when alerted by the flag, plus motivational reminders. We now seek to determine the effectiveness and cost-effectiveness of ARRISA in reducing asthma-related crisis events.MethodsWe are undertaking a pragmatic, two-arm, multicentre, cluster randomised controlled trial, plus health economic and process evaluation. We will randomise 270 primary care practices from throughout the UK covering over 10,000 registered patients with ‘at-risk asthma’ identified according to a validated algorithm. Staff in practices randomised to the intervention will complete two 45-min eLearning modules (an individually completed module giving background to ARRISA and a group-completed module to develop practice-wide pathways of care) plus a 30-min webinar with other practices. On completion of training at-risk patients’ records will be coded so that a flag appears whenever their record is accessed. Practices will receive a phone call at 4 weeks and a reminder video at 6 weeks and 6 months. Control practices will continue to provide usual care. We will extract anonymised routine patient data from primary care records (with linkage to secondary care data) to determine the percentage of at-risk patients with an asthma-related crisis event (accident and emergency attendances, hospitalisations and deaths) after 12 months (primary outcome). We will also capture the time to crisis event, all-cause hospitalisations, asthma control and any changes in practice asthma management for at-risk and all patients with asthma. Cost-effectiveness analysis and mixed-methods process evaluations will also be conducted.DiscussionThis study is novel in terms of using a practice-wide intervention to target and engage with patients at risk from their asthma and is innovative in the use of routinely captured data with record linkage to obtain trial outcomes.Trial registrationISRCTN95472706. Registered on 5 December 2014.
Highlights
Despite effective treatments and long-standing management guidelines, there are approximately 1400 hospital admissions for asthma weekly in the United Kingdom (UK), many of which could be avoided
The primary aim of this study is to determine whether the creation and integration of at-risk asthma registers into primary care, as conceptualised in our ’At-Risk Registers Integrated into primary care to Stop Asthma crises’ (ARRISA) intervention, reduces asthma-related crisis events (A&E attendances, hospitalisations and deaths) for at-risk patients over a 12-month period compared to control practices
We have developed an innovative multi-component practice-wide intervention based on the material delivered in the face-to-face training developed for the prior regional study [22], but incorporating eLearning modules similar to those that have been previously shown to be successful in changing clinician behaviours [26]
Summary
Despite effective treatments and long-standing management guidelines, there are approximately 1400 hospital admissions for asthma weekly in the United Kingdom (UK), many of which could be avoided. A secondary analysis of the intervention (ARRISA) suggested an improvement in the management of at-risk asthma patients in primary care. Asthma attacks result in major social, psychological and healthcare costs. Attacks are associated with a doubling of the healthcare costs for managing severe asthma in both children and adults [4, 5]. Given that there are an increasing number of effective treatments and long-standing, evidence-based management guidelines for asthma [7], the death rate for asthma has not reduced over recent years [8]
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