Abstract
BackgroundSupporting self-management behaviours is recommended guidance for people with asthma. Preliminary work suggests that a brief, intensive, patient-centred intervention may be successful in supporting people with asthma to participate in life roles and activities they value. We seek to assess the feasibility of undertaking a cluster-randomised controlled trial (cRCT) of a brief, goal-setting intervention delivered in the context of an asthma review consultation.Methods/designA two armed, single-blinded, multi-centre, cluster-randomised controlled feasibility trial will be conducted in UK primary care. Randomisation will take place at the practice level. We aim to recruit a total of 80 primary care patients with active asthma from at least eight practices across two health boards in Scotland (10 patients per practice resulting in ~40 in each arm). Patients in the intervention arm will be asked to complete a novel goal-setting tool immediately prior to an asthma review consultation. This will be used to underpin a focussed discussion about their goals during the asthma review. A tailored management plan will then be negotiated to facilitate achieving their prioritised goals. Patients in the control arm will receive a usual care guideline-based review of asthma. Data on quality of life, asthma control and patient confidence will be collected from both arms at baseline and 3 and 6 months post-intervention. Data on health services resource use will be collected from all patient records 6 months pre- and post-intervention. Semi-structured interviews will be carried out with healthcare staff and a purposive sample of patients to elicit their views and experiences of the trial. The outcomes of interest in this feasibility trial are the ability to recruit patients and healthcare staff, the optimal method of delivering the intervention within routine clinical practice, and acceptability and perceived utility of the intervention among patients and staff.Trial registrationISRCTN18912042
Highlights
Supporting self-management behaviours is recommended guidance for people with asthma
In the UK, 5.2 million people are currently being treated for asthma and an estimated 1 in 7 of the population will be diagnosed with asthma at some stage in their lives [3]
The guidance is informed by growing evidence that personalised asthma management plans— incorporating a living with asthma plan, asthma medication plan and asthma action plan [11]—negotiated in the light of patient goals have the potential to improve a range of clinical outcomes and quality of life, thereby resulting in reduced drug bills, hospitalisations and costs to healthcare systems [10,12,13,14]
Summary
Asthma affects more than 300 million people throughout the world with little evidence of a declining trend in prevalence [1,2]. To optimise the impact and use of asthma action plans, it has been suggested that they need to extend beyond the medical management of asthma to address patient goals in the wider context of their life and family and incorporate broader self-management strategies [19] This is consistent with current UK health policy, which reflects a paradigm shift away from the traditional, medical model of healthcare towards a patient-centred model of care that promotes collaborative partnership between patients and professionals in sharing information and agendas, setting goals and making decisions/plans for treatment and management [21,22]. To pilot the trial process including recruitment and performance of outcomes
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