Evaluating the Impact of GP and Practice Nurse Training in Self Regulations Skills on Patient Outcomes
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      This study will address the key question of developing shared understanding and negotiating
      mutually acceptable outcomes between people with asthma and healthcare professionals by
      applying theoretical knowledge of self regulation and communication skills learning and
      practice to asthma consultations. This study will facilitate integration of best practice
      into normal care using the BTS/SIGN asthma guidelines as the basis for structured care. This
      intervention has been show to be effective in the US. We aim to show that it can be effective
      in the UK setting in a cluster randomised control trial. We aim to modify and evaluate the
      intervention in such a way that it can be easily offered across UK primary care settings,
      with the possibility of significant benefits for patients. The intervention is based on the
      principle of empowering patients to manage their condition themselves, is consistent with the
      aims of Asthma UK, and, for this reason, we believe that Asthma UK may wish to be associated
      with this project.
    

Detailed description: 
      This study involves training GPs and nurses to recognize that patients differ in terms of
      asthma characteristics, such as symptoms and triggers, as well as personal attributes and
      lifestyles. The programme teaches professionals to work with patients to improve their asthma
      management; this involves helping people with asthma to observe themselves and their own
      actions, and learn from these, to support self-help behaviours, integrating these into their
      daily routines. The programme emphasizes good communication skills and working in partnership
      with patients, as well as up-dating doctors and nurses in current best practice for treating
      asthma. It is based on a programme successfully developed with American office based
      paediatricians, which resulted in greater parent satisfaction with asthma visits to doctors,
      and better asthma symptom control for patients. We wish to modify this American programme to
      make it more suitable for UK doctors, nurses and patients. We have also included a component
      into the programme to identify what exactly is effective in terms of how it impacts on
      clinician attitudes, beliefs and behaviour before delivering it more widely. The success of
      the project is evaluated not only by testing whether it improves the medical care and medical
      outcomes of patients of the health professionals taking part, but also by measuring whether
      patients are more satisfied with their consultations for asthma if their doctor or nurse has
      taken part in the programme. UK (http://www.sign.ac.uk/) evidence-based guidelines recommend
      helping those with asthma to control their symptoms and improve their quality of life through
      provision of education and individualised, written action plans. Our aim is to carry out a
      prospective, cluster randomised trial in general practices in Aberdeen and Glasgow, Scotland,
      to assess the impact of an educational intervention targeted at training practice nurses and
      general practitioners (GPs) in patient-centred asthma care; specifically in how to help
      patients develop asthma self regulation skills. The intervention is modified from a programme
      successfully implemented with American office based paediatricians, found to be effective in
      an US paediatric asthma population in terms of clinical outcomes and parent satisfaction (1).

      The hypothesis is that patients seen by doctors and nurses in primary care who have been
      trained in developing patient self regulation skills will have better asthma-related quality
      of life, control and clinical outcomes, and be more satisfied with the clinical consultation,
      than a control group of patients attending doctors and nurses who have not received training.

      One nominated GP and one nominated practice nurse from eight intervention practices will
      receive training modified from the Clark-Evans programme of asthma training. GPs and practice
      nurses nominated by eight control practices will deliver care as usual during the study.

      Patients will be targeted for recruitment when they present with symptoms or signs relating
      to poorly controlled asthma to the nominated GPs or Practice nurses. Questionnaire data will
      be collected from a baseline cohort, until 20 datasets per practice (16) have accrued (320 in
      total). Questionnaire data will then be collected from 20 patients per practice presenting in
      the same circumstances to the nominated GPs and Practice nurses in the intervention practices
      (160 in total). Questionnaire data will also be collected from 20 patients per practice
      presenting in the same circumstances to the nominated GPs and Practice nurses in the control
      practices, who will deliver care as usual (160 in total). The post training cohorts (control
      and intervention) will have follow up questionnaires at 3 and 12 months after the index
      consultation. Routinely available data will be collected for all patients with evidence of
      poorly controlled asthma before and after training. A total of 320 patients (160 to each arm)
      from a total of 16 practices (ie. 20 patients per practice) will ensure 90% power in the
      baseline and post-intervention cohorts at the 5% significance level (randomisation is by
      practice so this sample size calculation was inflated to correct for the intracluster
      correlation coefficient (ICC)) .

      The primary outcome measures will be the Mini AQLQ (2) and the Medical Interview Satisfaction
      Scale (MISS-21) (3). Secondary measures will be: Patients' Perception of their Involvement
      Questionnaire (4), the Asthma Control Questionnaire, (ACQ) (5). A theory of planned behaviour
      questionnaire will be used to examine how specific components of the training package
      influenced GP and practice nurse attitudes, behavioural intentions and self-efficacy. This
      will identify how and why the training worked, and inform further modifications of the
      programme to aid generalizability across UK settings.
    

Intervention name(s): modification of an interactive seminar
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Professional; patient partnership; patient satisfaction; professional training