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Clinical Trial
. 1999 May 8;318(7193):1251-5.
doi: 10.1136/bmj.318.7193.1251.

Clustered randomised trial of an intervention to improve the management of asthma: Greenwich asthma study

U N Premaratne  1 , J A Sterne, G B Marks, J R Webb, H Azima, P G Burney
Affiliations
Clinical Trial

Clustered randomised trial of an intervention to improve the management of asthma: Greenwich asthma study

U N Premaratne et al. BMJ. .

Abstract

Objectives: To evaluate the effectiveness of an asthma resource centre in improving treatment and quality of life for asthmatic patients.

Design: Community based randomised controlled trial.

Setting: 41 general practices in Greenwich with a practice nurse.

Subjects: All registered patients aged 15-50 years.

Intervention: Nurse specialists in asthma who educated and supported practice nurses, who in turn educated patients in the management of asthma according to the British Thoracic Society's guidelines.

Main outcome measures: Quality of life of asthmatic patients, attendance at accident and emergency departments, admissions to local hospitals, and steroid prescribing by general practitioners.

Results: Of 24 400 patients randomly selected and surveyed in 1993, 12 238 replied; 1621 were asthmatic of whom 1291 were sent a repeat questionnaire in 1996 and 780 replied. Of 24 400 patients newly surveyed in 1996, 10 783 (1616 asthmatic) replied. No evidence was found for an improvement in asthma related quality of life among newly surveyed patients in intervention practices compared with control practices. Neither was there evidence of an improvement in other measures of the quality of asthma care. Weak evidence was found for an improvement in quality of life in intervention practices among asthmatics registered with study practices in 1993 and followed up in 1996. Neither attendances at accident and emergency departments nor admissions for asthma showed any tendency to diverge in intervention and control practices over the study period. Steroid prescribing rates rose steadily during the study period. The average annual increase in steroid prescribing was 3% per year higher in intervention than control practices (95% confidence interval -1% to 6%, P=0.10).

Conclusions: This model of service delivery is not effective in improving the outcome of asthma in the community. Further development is required if cost effective management of asthma is to be introduced.

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Figures

Figure 1
Figure 1
Randomisation of general practices
Figure 2
Figure 2
Surveys of patients used to evaluate intervention
Figure 3
Figure 3
Ratio of total steroid prescriptions to practice population, by quarter
See this image and copyright information in PMC

Comment in

  • Greenwich asthma study.
    Parnell H, Cooke NT. Parnell H, et al. BMJ. 1999 Sep 11;319(7211):709. doi: 10.1136/bmj.319.7211.709. BMJ. 1999. PMID: 10480842 Free PMC article. No abstract available.
  • Greenwich asthma study. Study's conclusions are premature.
    Feder G, Griffiths C, Foster G, Ahmed S, Maclaren D, Carter Y. Feder G, et al. BMJ. 2000 Feb 26;320(7234):580-1. doi: 10.1136/bmj.320.7234.580. BMJ. 2000. PMID: 10688572 Free PMC article. No abstract available.

References

    1. British Thoracic Society. Guidelines on the management of asthma. Statement by the British Thoracic Society, the British Paediatric Association, the Research Unit of the Royal College of Physicians of London, the King's Fund Centre, the National Asthma Campaign, the Royal College of General Practitioners, the General Practitioners in Asthma Group, the British Association of Accident and Emergency Medicine, and the British Paediatric Respiratory Group. Thorax. 1993;48:1–24S. - PMC - PubMed
    1. British Thoracic Society. The British guidelines on asthma management—1995 review and position statement. Thorax. 1997;52:1–21S. - PubMed
    1. Department of Health. Terms of service for doctors in general practice. London: DoH; 1990.
    1. Charlton I, Charlton G, Broomfield J, Mullee MA. Audit of the effect of a nurse run asthma clinic on workload and patient morbidity in a general practice. Br J Gen Pract. 1991;41:227–231. - PMC - PubMed
    1. Charlton I, Charlton G, Broomfield J, Campbell M. An evaluation of a nurse-run asthma clinic in general practice using an attitudes and morbidity questionnaire. Fam Pract. 1992;9:154–160. - PubMed

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