Abstract
Background: Asthma is a common long-term condition and major public health problem. Supported self-management for asthma, that includes a written personalised asthma action plan, supported by regular professional review, reduces unscheduled consultations, and improves asthma outcomes and quality of life. However, despite unequivocal inter/national guideline recommendations, supported self-management is poorly implemented in practice. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART)
implementation strategy has been developed to address this challenge. The aim of this implementation trial is to determine whether facilitated delivery of the IMP2ART strategy increases the provision of asthma action plans and reduces unscheduled care in the context
of routine UK primary care.
Methods: IMP2ART is a parallel group, cluster-randomised controlled hybrid II implementation trial. 144 general practices will be randomly assigned to either the IMP2ART implementation strategy or control group. Following a facilitation workshop, implementation group practices will receive organisational resources to help them prioritise supported self-management (including audit and feedback; an IMP2ART asthma review template), training for professionals, and resources to support patients to self-manage their asthma. The control group will continue with usual asthma care. The primary clinical outcome is the between-group difference in unscheduled care in the second year after randomisation (i.e. between 12 and 24 months post-randomisation) assessed from routine data. Additionally, a primary implementation outcome of asthma action plan ownership at 12 months will be assessed by questionnaire to a random sub-group of people with asthma. Secondary outcomes include the
number of asthma reviews conducted, prescribing outcomes (reliever medication and oral steroids), asthma symptom control, patients’ confidence in self-management and professional support, and resource use. A health economic analysis will assess cost-effectiveness, and a mixed methods process evaluation will explore implementation, fidelity and adaptation.
Discussion: The evidence for supported asthma self-management is overwhelming. This study will add to the literature regarding strategies that can effectively implement supported self-management in primary care to reduce unscheduled consultations and improve asthma outcomes and quality of life.
implementation strategy has been developed to address this challenge. The aim of this implementation trial is to determine whether facilitated delivery of the IMP2ART strategy increases the provision of asthma action plans and reduces unscheduled care in the context
of routine UK primary care.
Methods: IMP2ART is a parallel group, cluster-randomised controlled hybrid II implementation trial. 144 general practices will be randomly assigned to either the IMP2ART implementation strategy or control group. Following a facilitation workshop, implementation group practices will receive organisational resources to help them prioritise supported self-management (including audit and feedback; an IMP2ART asthma review template), training for professionals, and resources to support patients to self-manage their asthma. The control group will continue with usual asthma care. The primary clinical outcome is the between-group difference in unscheduled care in the second year after randomisation (i.e. between 12 and 24 months post-randomisation) assessed from routine data. Additionally, a primary implementation outcome of asthma action plan ownership at 12 months will be assessed by questionnaire to a random sub-group of people with asthma. Secondary outcomes include the
number of asthma reviews conducted, prescribing outcomes (reliever medication and oral steroids), asthma symptom control, patients’ confidence in self-management and professional support, and resource use. A health economic analysis will assess cost-effectiveness, and a mixed methods process evaluation will explore implementation, fidelity and adaptation.
Discussion: The evidence for supported asthma self-management is overwhelming. This study will add to the literature regarding strategies that can effectively implement supported self-management in primary care to reduce unscheduled consultations and improve asthma outcomes and quality of life.
| Original language | English |
|---|---|
| Article number | 252 |
| Journal | Trials |
| Volume | 24 |
| DOIs | |
| Publication status | Published - 3 Apr 2023 |
Bibliographical note
Acknowledgements: The authors acknowledge all members of the IMP2ART programme group for their contributions including: Brian McKinstry, Aziz Sheikh (University of Edinburgh); Sandra Eldridge, Chris Griffiths (Queen Mary University of London); Steven Julious (University of Sheffield); Ann-Louise Caress (University of Huddersfield). Dr Susan Morrow was Programme Manager during early stages of this work. Emily Healy provided invaluable administrative support. We are grateful to the Primary Care Respiratory Society for recruiting members for the IMP2ART Professional Advisory Group: Dr Noel Baxter, Dr Stephen Gaduzo,Val Gerrard, Dr Katherine Hickman, Dr Stephen Gaduzo, Dr Binita Kane, Dr Duncan Keeley, Vikki Knowles, Ren Lawlor, Ruth McArthur, Debbie Roots, Anne Rodman, Laura Rush, Dr Mukesh Singh, Iain Small, Carol Stonham, Dr Andrew Whittamore. We thank the IMP2ART Patient and Public Involvement Group for their advice: Anthony McGuiness, Bill Day, David Weatherill, Daniel Russell, Eve Smyth, Irena Paterson, Kieron Blake. We acknowledge the helpful advice of the Independent Programme Steering Committee Professor Robbie Foy
(chair), Professor Kate Jolly, Professor Obi Ukoumunne, and David Supple.
Funding: The National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research (Reference Number RP-PG-1016-20008). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data, or decision to publish. The Asthma UK Centre for Applied Research (reference Asthma UK: AC-2012-01) funded some pre-grant work on the theoretical development of the implementation strategy.
Education for Health developed the education modules and Optimum Patient Care developed the templates and audit and feedback components of the implementation strategy.
Data Availability Statement
Due to the confidentiality of NHS routine data required for this trial, data will not be made available.Keywords
- Protocol
- randomised controlled implementation trial
- IMP2ART
- asthma
- self-management
- primary care
Access to Document
- McClatchey_etal_T_Implementing_Improved_Asthma_VOR
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