Abstract
Background Avoiding emergency hospital admissions is a crucial aspect of asthma care. A small-scale regional trial suggested that the implementation of at-risk registers for asthma in primary care may improve hospital admission rates.
Aim To assess, via a national study, whether the ARRISA-UK intervention reduced asthma crisis events.
Methods Cluster randomised trial of a complex intervention across 275 UK primary care practices. The intervention comprised of identification of those at-risk, practice-based training regarding at-risk asthma, a clinical decision support system alerting practice staff to patients’ at-risk status to facilitate prompt and opportunistic care, and practice support. Control practices continued with usual care. Patients (n=10945) were included if they were identified as being at-risk unless they declined data sharing. Routine data, with linkage between primary and secondary care, captured the primary endpoint of asthma-related crisis events (hospitalisation, A&E attendances or death). The number of prescriptions of prednisolone for asthma attacks was captured amongst other processes of care.
Results Data from 185 practices (6207 patients) were available for a complete case analysis. There was no significant effect on the asthma crisis events: intervention 185/2959 (6.3%) control 235/3248 (7.2%) odds ratio (OR) 0.87 (95% CI 0.69,1.09; p=0.220), nor for the components of this composite endpoint. When adjusting for any baseline asthma-related hospitalisation and A&E attendance the adjusted OR was 0.82 (0.66,1.03; p=0.088). There was no significant difference in prescriptions of prednisolone: intervention 1116, control 1234 OR 1.2(0.99,1.5; p=0.062) nor when adjusted OR 1.17 (0.98, 1.4; p=0.074).
Conclusion The primary analysis did not show a statistically significant effect of the ARRISA intervention on the primary outcome. Further analysis is required to determine whether this intervention is cost-effective and to identify subgroups that may have benefitted.
Aim To assess, via a national study, whether the ARRISA-UK intervention reduced asthma crisis events.
Methods Cluster randomised trial of a complex intervention across 275 UK primary care practices. The intervention comprised of identification of those at-risk, practice-based training regarding at-risk asthma, a clinical decision support system alerting practice staff to patients’ at-risk status to facilitate prompt and opportunistic care, and practice support. Control practices continued with usual care. Patients (n=10945) were included if they were identified as being at-risk unless they declined data sharing. Routine data, with linkage between primary and secondary care, captured the primary endpoint of asthma-related crisis events (hospitalisation, A&E attendances or death). The number of prescriptions of prednisolone for asthma attacks was captured amongst other processes of care.
Results Data from 185 practices (6207 patients) were available for a complete case analysis. There was no significant effect on the asthma crisis events: intervention 185/2959 (6.3%) control 235/3248 (7.2%) odds ratio (OR) 0.87 (95% CI 0.69,1.09; p=0.220), nor for the components of this composite endpoint. When adjusting for any baseline asthma-related hospitalisation and A&E attendance the adjusted OR was 0.82 (0.66,1.03; p=0.088). There was no significant difference in prescriptions of prednisolone: intervention 1116, control 1234 OR 1.2(0.99,1.5; p=0.062) nor when adjusted OR 1.17 (0.98, 1.4; p=0.074).
Conclusion The primary analysis did not show a statistically significant effect of the ARRISA intervention on the primary outcome. Further analysis is required to determine whether this intervention is cost-effective and to identify subgroups that may have benefitted.
| Original language | English |
|---|---|
| Article number | A76 |
| Number of pages | 1 |
| Journal | Thorax |
| Volume | 79 |
| Issue number | Suppl. 2 |
| DOIs | |
| Publication status | Published - 3 Nov 2024 |