The At-Risk Registers Integrated into primary care to Stop Asthma crises in the UK (ARRISA-UK) trial: Has the ARRISA-UK intervention led to perceived improvements in the management of ‘at-risk’ asthma patients in primary care?

Problem

There are an estimated 334 million asthma sufferers worldwide and most morbidity and mortality due to asthma should be preventable. The ARRISA-UK cluster-randomised control trial is evaluating across 275 GP practices whether a practice-level intervention reduces the proportion of ‘at-risk’ asthma patients experiencing asthma-related A&E attendances, hospitalisations or death over 12 months, compared to usual care. The intervention involved identifying and adding flags to the records of at-risk asthma patients, and staff representatives completing online training to support implementation of agreed practice-wide actions in response to the flags. The student-led study reported here is part of a wider process evaluation and investigates staff perceptions of the ARRISA-UK intervention, including reported changes in their care of at-risk asthma patients following the intervention.

Approach

The study uses data collected via online questionnaires sent to staff representatives at all participating intervention practices at the end of the 1-year study follow up. Questions were tailored to the participant’s role in the practice and comprised Likert-type and free-text responses.Quantitative and qualitative (e.g. content) analyses of data are being conducted to generate descriptive statistics and themes from the responses about the intervention’s acceptability, feasibility and impact in managing at-risk asthma patients, and whether practices would continue using the intervention. Data from staff in different roles, and across different types of practices will also be compared to explore any potential differences in perceptions.

Findings

Of the 129 intervention practices remaining in the study and sent a questionnaire (93% of total), 121 (94%) responded, returning 288 questionnaires from staff representatives to date (data collection is ongoing until end of November). Practices returned between 1 and 6 questionnaires, with 27% from GPs, 25% from nurses, 19% from practice managers, 13% from administrative staff, 5% from pharmacists or dispensers, 3% from receptionists, 2% from healthcare assistants and 7% from others. Detailed findings on perceptions of the intervention, reported impacts on the care of at-risk asthma patients and any identified areas for improvement amongst these different staff groups will be presented.

Consequences

Findings from this study will shed light on potential mechanisms of action of the ARRISA-UK intervention which can be explored in further analyses when objective data on care processes and outcomes are available. Any identified differences in perceptions between staff in different roles and across different practices can be used to inform how any future implementation of the intervention can be improved to make it feasible, acceptable and useful to all staff groups and practices.