Asthma Respiratory Asthma
Conditions
Interventions
Practices randomised to the intervention arm will add at-risk asthma patients to an at-risk register. Identified patients will be added to an asthma risk register involving:
1. Electronic tagging of
Sponsors
Asthma UK (UK)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: PRACTICES: 1. Participation is open to all practices with adequate computer systems which are used to support routine consultations 2. Practices covering urban and rural populations, deprived and affluent areas and various practice sizes and set-ups PATIENTS: High risk patients aged 5+ years at participating practices will, according to British asthma guideline recommendations, be identified on the basis of having: 1. Severe asthma, recognised by one or more of: 1.1. Previous near-fatal asthma 1.2. Hospital admission for asthma in the last five years 1.3. Two or more attendances at Accident and Emergency (A&E) or out-of-hours services for asthma in the last year 1.4. Requiring step four or five treatment 1.5. Brittle asthma PLUS: 2. A record in the notes (of patients or their primary carers for children) of adverse behavioural or psychosocial characteristics including one or more of: 2.1. Poor adherence to recommended management 2.2. Failure to attend primary care or hospital appointments 2.3. Self-discharge from hospital 2.4. Psychosis, depression, other psychiatric illness or deliberate self-harm 2.5. Current or recent major tranquiliser use 2.6. Alcohol or drug abuse 2.7. Denial 2.8. Obesity 2.9. Learning difficulties 2.10. Employment problems 2.11. Income problems 2.12. Social isolation 2.13. Childhood abuse 2.14. Severe domestic, marital or legal stress
Exclusion criteria
Exclusion criteria: PRACTICES: Those with pre-existing at-risk asthma registers or similar strategies to study intervention. PATIENTS: Patients who meet the inclusion criteria but are felt not appropriate to be included on an at-risk register for some other factor will be individually negotiated.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Moderate-severe asthma exacerbations, measured at one year. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Exacerbations from: 1.1. Death or hospitalisation 1.2. Emergency attendance (at the hospital, the practice or via a home visit) 1.3. Out-of-hours medical contact 1.4. A course of oral prednisolone or a boost in oral steroids for those receiving them regularly 2. Asthma-related routine primary and secondary care attendances and medication use 3. Healthcare costs All secondary outcomes measured at one year. | — |
Countries
United Kingdom
Outcome results
None listed