TY - JOUR
T1 - IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care
T2 - study protocol for a cluster randomised controlled implementation trial
AU - IMP2 ART Programme Group
AU - McClatchey, Kirstie
AU - Hammersley, Vicky
AU - Steed, Liz
AU - Sheringham, Jessica
AU - Marsh, Viv
AU - Barat, Atena
AU - Delaney, Brigitte
AU - Hamborg, Thomas
AU - Fitzsimmons, Deborah
AU - Holmes, Steve
AU - Jackson, Tracy
AU - Ehrlich, Elisabeth
AU - Morgan, Noelle
AU - Saxon, Ann
AU - Preston, Megan
AU - Price, David
AU - Taylor, Stephanie J C
AU - Pinnock, Hilary
N1 - Funding Information:
Our systematic meta-review, funded by the National Institute for Health and Care Research (NIHR) Health Service and Delivery Research (HS&DR), synthesised evidence from 27 systematic reviews (270 RCTs) and concluded that supported self-management reduces hospitalisations, accident and emergency (A&E) attendances and unscheduled consultations, and improves markers of control and quality-of-life for people with asthma []. A written personalised asthma action plan, completed as part of a self-management discussion and reviewed regularly, empowers patients to recognise deterioration and take appropriate action (e.g. increasing/commencing medication; seeking medical help)[–]. The cost of providing self-management support (estimated in a recent network meta-analysis for asthma as a 2-h investment in the first year []) is offset by the reduction in hospitalisations and unscheduled healthcare []. Effectiveness of supported self-management has been demonstrated in diverse cultural groups [–], children [–], adolescents [, ], adults [] and elderly populations [, ], and in both primary/secondary healthcare settings [–]. A range of modes of delivery (including telehealth) [–] may be used to suit preferences and context.
Funding Information:
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.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/4/3
Y1 - 2023/4/3
N2 - 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. One hundred forty-four 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.TRIAL REGISTRATION: ISRCTN15448074. Registered on 2 December 2019.
AB - 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. One hundred forty-four 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.TRIAL REGISTRATION: ISRCTN15448074. Registered on 2 December 2019.
KW - Humans
KW - Self-Management
KW - Quality of Life
KW - Asthma/therapy
KW - General Practice
KW - Primary Health Care
KW - Randomized Controlled Trials as Topic
U2 - 10.1186/s13063-023-07253-9
DO - 10.1186/s13063-023-07253-9
M3 - Article
C2 - 37013577
SN - 1745-6215
VL - 24
SP - 252
JO - Trials
JF - Trials
IS - 1
M1 - 252
ER -