TRAINS: a pragmatic cluster RCT to prevent summer holiday drop in asthma prescription uptake in school-age children.

Problem

Abstract Following the summer break, asthma exacerbations peak in school-aged children. Research shows a drop in prescription pickups in August, followed by a rise in unscheduled healthcare provider visits in the next period. As an investigation of this, a cluster randomized controlled trial (PLEASANT) revealed that a family doctor's reminder letter to parents of asthmatic children during summer vacation increased prescription collections in August by 30%, and the number of unscheduled care visits decreased after school was back in September. A cost saving of £36.07 per patient per year was also estimated as a result of this intervention. Objective: To conduct a randomised trial to assess whether advising GP practices of an evidence-based intervention leads to the use of that intervention by GP practices.

Approach

Design: A pragmatic cluster randomised trial using routine data, which utilises the Clinical Practice Research Datalink (CPRD) to both deliver the intervention and gather all data.Participants: 1389 general practitioner practices in England were included (694 in the intervention group and 695 in the control group).Intervention arm: Received a letter from CPRD regarding the findings of the PLEASANT study, along with recommendations. The letter was sent in June 2021 via postal mail and email to the asthma lead or practice manager.Control arm: Usual careRandomisation: GP practices were stratified by practice size and randomly assigned to the intervention or control groupMain outcome: Proportion of children with asthma who have a prescription for an asthma preventer medication in August and September 2021.

Findings

We are currently engaged in a comprehensive analysis of the data and findings. By the time the conference rolls around, we will be ready to present the results to the attendees.

Consequences

Sending an intervention, such as a letter, to General Practitioners (GPs) can increase GPs' awareness of the issue being addressed, leading to more informed decision making and better patient care.