Asthma UK Centre for Applied Research, Old Medical School, Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
Wolfson Institute of Population Health, Mary University of London, London, Queen, UK.
Trials. 2023 Apr 3;24(1):252. doi: 10.1186/s13063-023-07253-9.
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 (IMPART) implementation strategy has been developed to address this challenge. The aim of this implementation trial is to determine whether facilitated delivery of the IMPART strategy increases the provision of asthma action plans and reduces unscheduled care in the context of routine UK primary care.
IMPART is a parallel group, cluster randomised controlled hybrid II implementation trial. One hundred forty-four general practices will be randomly assigned to either the IMPART 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 IMPART 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.
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.
ISRCTN15448074. Registered on 2 December 2019.
哮喘是一种常见的长期疾病，也是一个主要的公共卫生问题。支持性的哮喘自我管理，包括一份个性化的书面哮喘行动计划，并定期接受专业人员的审查，可以减少非计划性就诊，并改善哮喘的结果和生活质量。然而，尽管国际和国内指南有明确的建议，支持性的自我管理在实践中仍未得到很好的实施。为了解决这一挑战，开发了实施改进的哮喘自我管理作为常规（IMPART）实施策略。本实施试验的目的是确定促进实施 IMPART 策略是否能增加哮喘行动计划的提供，并减少常规英国初级保健中的非计划性护理。
IMPART 是一项平行组、群组随机对照混合 II 实施试验。将 144 家全科诊所随机分配到 IMPART 实施策略组或对照组。在一个促进研讨会之后，实施组实践将获得组织资源，以帮助他们优先考虑支持性自我管理（包括审计和反馈；IMPART 哮喘审查模板），为专业人员提供培训，并为患者提供资源，以支持他们自我管理哮喘。对照组将继续进行常规的哮喘护理。主要临床结果是在随机分组后第二年（即随机分组后 12 至 24 个月）的非计划性护理之间的组间差异，通过常规数据评估。此外，将通过对随机亚组哮喘患者的问卷调查来评估 12 个月时拥有哮喘行动计划的主要实施结果。次要结果包括进行哮喘审查的次数、处方结果（缓解药物和口服类固醇）、哮喘症状控制、患者对自我管理和专业支持的信心以及资源使用情况。一项健康经济分析将评估成本效益，混合方法的过程评估将探索实施、保真度和适应性。
支持性哮喘自我管理的证据是压倒性的。这项研究将增加关于在初级保健中有效实施支持性自我管理以减少非计划性就诊并改善哮喘结果和生活质量的策略的文献。
ISRCTN83526631。于 2019 年 12 月 2 日注册。
