Title: Evaluation of the Bronchiectasis Empowerment Tool (BET)
Funder: Department of Health (England)

Abstract: Background Patients with bronchiectasis have irreversible bronchial dilatation with an increased risk of respiratory tract infections. These need prompt and appropriate treatment. Patient self-management plans/tools have been used in other respiratory conditions similar to bronchiectasis, for many years, with improved healthcare outcomes. Although advocated by the National Guidelines, there is no data on the beneficial effects of self-management plans in bronchiectasis. In an ongoing collaboration of patients with, and professionals treating, bronchiectasis we have developed the Bronchiectasis Empowerment Tool (BET). This is a one-page action plan, incorporated within a patient-held pack containing concise information about bronchiectasis and optional notepads to encourage patient note taking to gain insight and information about their condition. The tool has been developed in collaboration with patients and healthcare providers and is easy to use with pictographical instructions. It is designed work alongside, rather than to replace, existing care in order to enhance patients ability to manage their condition. Aims Our aim is to conduct a study to evaluate the effectiveness and cost-effectiveness of the Bronchiectasis Empowerment Tool (BET) as a support to patients throughout their healthcare journey. We will assess patients’ self-efficacy, which is the confidence patients have in their ability to successfully deal with their condition, using the validated Chronic Disease Self-Efficacy Scale. We will also measure health care contacts, health related quality of life, appropriateness of antibiotic therapy and costs from questionnaires. To add a qualitative dimension pertinet to successful integration to practice we will seek the opinions of patients at the end of the study. Plan This will be a randomised controlled 2-centre study to evaluate the effectiveness and cost-effectiveness of a patient self-management plan in patients with bronchiectasis. Two hundred and twenty patients will be identified from clinic lists and randomised to receive standard care or standard care with the addition of BET. Patients randomised to the intervention will receive the plan documents and will be shown how to use BET. All patients will receive the British Lung Foundation bronchiectasis information leaflet and British Thoracic Society Physiotherapy Guideline. At baseline and after 12 months patients will complete the chronic disase self-efficacy scale, the St Georges Respiratory Questionnaire (a validated respiratory quality of life tool), the Euroqol-5D (EQ5D) (to determine health utility) and resource use questionnaires. In addition patients will complete chronic disease self efficacy scale, resource use and health utility questionnaires (which should take 10-15 minutes to complete in total) by mail every 3 months. Exacerbation data will be obtained from resource questionnaire. Patients will be asked to collect the packet inserts for all antibiotics which will be cross-referenced to antibiotic sensitivities obtained by microbiology records to determine appropriateness of prescriptions. Patients’ views about BET will be captured to aid integration using an exit questionnaire and focus groups. Potential Benefit Patients with bronchiectasis have impaired quality of life and increased health care utilisation. We hope to show that addition of BET to clinical care improves patients’ self-efficacy, their quality of life and reduces their health care resource use and costs through appropriate and prompt escalation of care. We hope that the tool will improve communication between primary and secondary care healthcare providers and patients. The findings of the study can be implemented immediately with minimal resource implications and thus even minimal benefits may provide overall health economic advantage.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: RESPIRATORY