Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2007 Apr 24:8:23.
doi: 10.1186/1471-2296-8-23.

Practice development plans to improve the primary care management of acute asthma: randomised controlled trial

Juliet M Foster  1 , Gaylor Hoskins, Barbara Smith, Amanda J Lee, David Price, Hilary Pinnock
Affiliations
Randomized Controlled Trial

Practice development plans to improve the primary care management of acute asthma: randomised controlled trial

Juliet M Foster et al. BMC Fam Pract. .

Abstract

Background: Our professional development plan aimed to improve the primary care management of acute asthma, which is known to be suboptimal.

Methods: We invited 59 general practices in Grampian, Scotland to participate. Consenting practices were randomised to early and delayed intervention groups. Practices undertook audits of their management of all acute attacks (excluding children under 5 years) occurring in the 3 months preceding baseline, 6-months and 12-months study time-points. The educational programme [including feedback of audit results, attendance at a multidisciplinary interactive workshop, and formulation of development plan by practice teams] was delivered to the early group at baseline and to the delayed group at 6 months. Primary outcome measure was recording of peak flow compared to best/predicted at 6 months. Analyses are presented both with, and without adjustment for clustering.

Results: 23 consenting practices were randomised: 11 to early intervention. Baseline practice demography was similar. Six early intervention practices withdraw before completing the baseline audit. There was no significant improvement in our primary outcome measure (the proportion with peak flow compared to best/predicted) at either the 6 or 12 month time points after adjustment for baseline and practice effects. However, the between group difference in the adjusted combined assessment score, whilst non-significant at 6 months (Early: 2.48 (SE 0.43) vs. Delayed 2.26 (SE 0.33) p = 0.69) reached significance at 12 m (Early:3.60 (SE 0.35) vs. Delayed 2.30 (SE 0.28) p = 0.02).

Conclusion: We demonstrated no significant benefit at the a priori 6-month assessment point, though improvement in the objective assessment of attacks was shown after 12 months. Our practice development programme, incorporating audit, feedback and a workshop, successfully engaged the healthcare team of participating practices, though future randomised trials of educational interventions need to recognise that effecting change in primary care practices takes time. Monitoring of the assessment of acute attacks proved to be a feasible and responsive indicator of quality care.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Audit form for the critical event analysis.
Figure 2
Figure 2
Example of 'post-intervention' feedback provided to practices.
Figure 3
Figure 3
Proforma to facilitate the formulation of a Practice Development Plan.
Figure 4
Figure 4
Flow of participating practices through each stage of the trial.
Figure 5
Figure 5
Timescale of changes in combined scores within the early and delayed intervention groups.
See this image and copyright information in PMC

References

    1. British Thoracic Society and Scottish Intercollegiate Guidelines Network British guideline on the management of asthma. Thorax. 2003;58:1–94. November 2005 update available from http://www.brit-thoracic.org.uk and http://www.sign.ac.uk (accessed June 2006) - PubMed
    1. Global Strategy for Asthma Management and Prevention GINA Workshop Report: updated October 2005. http://www.ginasthma.com (accessed June 2006).
    1. Jones K. Asthma care in general practice – time for a revolution? Br J Gen Pract. 1991;41:224–226. - PMC - PubMed
    1. Dennis SM, Edwards S, Partridge MR, Pinnock HJ, Qureshi S. The dissemination of the British Guideline on the Management of Asthma 2003. Respir Med. 2004;98:832–837. doi: 10.1016/j.rmed.2004.02.018. - DOI - PubMed
    1. Partridge MR, Harrison BDW, Rudolph M, Bellamy D, Silverman M. The British Asthma Guidelines – their production, dissemination and implementation. Respir Med. 1998;92:1046–1052. doi: 10.1016/S0954-6111(98)90353-5. - DOI - PubMed

Publication types