Julious Steven A, Horspool Michelle J, Davis Sarah, Franklin Matthew, Smithson W Henry, Norman Paul, Simpson Rebecca M, Elphick Heather, Bortolami Oscar, Cooper Cindy
Medical Statistics Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Health Economics and Decision Sciences, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
BMJ Open. 2018 Apr 20;8(4):e017367. doi: 10.1136/bmjopen-2017-017367.
Asthma is seasonal with peaks in exacerbation rates in school-age children associated with the return to school following the summer vacation. A drop in prescription collection in August is associated with an increase in the number of unscheduled contacts after the school return.
To assess whether a public health intervention delivered in general practice reduced unscheduled medical contacts in children with asthma.
Cluster randomised trial with trial-based economic evaluation. Randomisation was at general practice level, stratified by size of practice. The intervention group received a letter from their general practitioner (GP) in late July outlining the importance of (re)taking asthma medication before the return to school. The control group was usual care.
General practices in England and Wales.
12 179 school-age children in 142 general practices (70 randomised to intervention).
Proportion of children aged 5-16 years who had an unscheduled contact in September. Secondary endpoints included collection of prescriptions in August and medical contacts over 12 months (September-August). Economic endpoints were quality-adjusted life-years gained and health service costs.
There was no evidence of effect (OR 1.09; 95% CI 0.96 to 1.25 against treatment) on unscheduled contacts in September. The intervention increased the proportion of children collecting a prescription in August by 4% (OR 1.43; 95% CI 1.24 to 1.64). The intervention also reduced the total number of medical contacts between September-August by 5% (incidence ratio 0.95; 95% CI 0.91 to 0.99).The mean reduction in medical contacts informed the health economics analyses. The intervention was estimated to save £36.07 per patient, with a high probability (96.3%) of being cost-saving.
The intervention succeeded in increasing children collecting prescriptions. It did not reduce unscheduled care in September (the primary outcome), but in the year following the intervention, it reduced the total number of medical contacts.
ISRCTN03000938; Results.
哮喘具有季节性，学龄儿童哮喘加重率在暑假后返校时达到峰值。8月份处方取药量下降与返校后非预约就诊人数增加有关。
评估在全科医疗中实施的公共卫生干预措施是否能减少哮喘儿童的非预约医疗就诊。
基于试验的经济评估的整群随机试验。随机分组在全科医疗层面进行，按诊所规模分层。干预组在7月下旬收到其全科医生（GP）的一封信，概述在返校前（重新）服用哮喘药物的重要性。对照组接受常规护理。
英格兰和威尔士的全科医疗诊所。
142家全科医疗诊所中的12179名学龄儿童（70家随机分配到干预组）。
5至16岁儿童在9月份非预约就诊的比例。次要终点包括8月份的处方取药量和12个月（9月至次年8月）内的医疗就诊情况。经济终点是获得的质量调整生命年和卫生服务成本。
没有证据表明干预措施对9月份的非预约就诊有效果（与治疗相比，比值比为1.09；95%置信区间为0.96至1.25）。干预措施使8月份取药的儿童比例增加了4%（比值比为1.43；95%置信区间为1.24至1.64）。干预措施还使9月至次年8月期间的医疗就诊总数减少了5%（发病率比为0.95；95%置信区间为0.91至0.99）。医疗就诊次数的平均减少为卫生经济学分析提供了依据。估计该干预措施每位患者可节省36.07英镑，且很有可能（96.3%）节省成本。
该干预措施成功增加了儿童的处方取药量。它没有减少9月份的非预约医疗服务（主要结局），但在干预后的一年里，它减少了医疗就诊的总数。
ISRCTN03000938；结果
