Can Education for South Asians With Asthma and Their Clinicians Reduce Unscheduled Care? A Randomised Trial
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional
Phase: Phase 1

Summary: 
      People from ethnic minority groups suffer worse ill-health from asthma than those from
      majority groups. No studies have reduced emergency care for people from minority groups. We
      have developed an education programme to address barriers to improved care for south Asian
      people with asthma. The study is set in Tower Hamlets and Newham - the UK's most deprived and
      ethnically diverse boroughs. We will invite all the local GP practices to take part, and
      using a computer programme, randomised them (like tossing a coin) into two groups - a group
      receiving usual care and a group receiving our educational programme. This comprises:

        -  Education for specialist nurse and GPs and practice nurses, using our adaptation of an
           American education course, designed to improve shared-decision making, goal-setting and
           patient-clinician partnership.

        -  Lay-led 'expert-patient' education in small groups for patients, using an adaptation of
           another American course.

        -  Improved follow-up in primary care through appointment-booking by the specialist
           nurse.We will invite south Asians aged 3-65 years with asthma after A&E attendance or
           hospital admission to take part. Those registered with practices receiving the
           educational programme will see the trial specialist nurse in a nurse-run clinic, where
           the nurse:

             1. provides self-management advice and a treatment plan,

             2. makes a follow-up appointment in primary care

             3. makes an appointment for lay-led 'expert-patient' sessions.Patients registered with
                'usual care' practices receive usual care.

      We will decide if our education programme works by comparing the number of emergency visits
      to GPs and hospital between the two groups.
    

Detailed description: 
      Health inequalities between ethnic minority and majority groups exist for all chronic
      diseases and are a government priority for action. For asthma, poorer outcomes for people
      from minority groups are a universal finding. No randomised trials have reduced emergency
      asthma care for ethnic minority groups.

      We have developed an intervention to address barriers to improved asthma care for south Asian
      people with asthma. This cluster randomised controlled trial tests whether education for
      south Asians with asthma and their clinicians can reduce unscheduled care. The trial is set
      in Tower Hamlets and Newham - boroughs with UK's 1st and 3rd highest ethnic minority
      populations.

      We will invite all 94 general practices in these boroughs to take part. Practices will be
      randomised with stratification to intervention and control groups. The intervention
      comprises:

        -  Education for intervention specialist nurse and GPs and practice nurses from
           intervention practices, using our adaptation of Clarke's self-regulation education
           programme, designed to improve shared-decision making, goal-setting and
           patient-clinician partnership.

        -  Lay-led 'expert-patient' education in small groups for patients, using an adaptation of
           Lorig's chronic disease self-management programme.

        -  Improved follow-up in primary care through appointment-booking by the specialist nurse.

      We will recruit south Asians aged 3-65 years with asthma after A&E attendance or hospital
      admission. Participants registered with intervention practices will see the trial specialist
      nurse in a nurse-run hospital clinic, where the nurse:

        1. provides self-management advice and a treatment plan,

        2. makes a follow-up appointment for the patient in primary care

        3. makes an appointment for lay-led 'expert-patient' sessions.

      Participants registered with control practices receive usual care. Primary outcomes are time
      to first unscheduled contact with acute asthma, and proportion of participants with
      unscheduled care, assessed from patient records 12 months after recruitment. Secondary
      outcomes are generic (EQ5D) and disease specific quality of life (AQ20 and North of England
      scales), prescribing and costs. The trial is powered to detect a 20% reduction in patients
      attending with unscheduled care (80% power 5% significance). Outcomes will be gathered by
      blinded researchers. Analysis will be carried out blind to allocation. Cost-effectiveness
      will be assessed using standard incremental cost-effectiveness ratios.
    

Intervention name(s): PACE (Professional Asthma Care Education); Lay Led Expert Patient Programme; Asthma self management education by a specialist nurse
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Education for intervention specialist nurse and GPs and practice nurses from intervention practices, using our adaptation of Clarke's self-regulation education programme, designed to improve shared-decision making, goal-setting and patient-clinician partnership.; Lay-led 'expert-patient' education in small groups for patients, using an adaptation of Stanford University's chronic disease self-management programme.; asthma education and self management, asthma action plans
Other intervention name(s): Expert Patient Programme
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: ethnicity; primary care; education