Hilary Pinnock, Vicky Hammersley, Francis Appiagyei, Atena Barat, Brigitte Delaney, Deb Fitzsimmons, Thomas Hamborg, Tracy Jackson, Mari Jones, Steven Julious, Catherine MacLeod, Viv Marsh, Kirstie McClatchey, Noelle Morgan, David Price, Jessica Sheringham, Liz Steed, Beth Stuart, Steph Taylor
Introduction: For 35 years guidelines have recommended supported self-management for asthma, but implementation remains poor.
Aim: To test the effectiveness of facilitated delivery of the IMP2ART implementation strategy (IMP) in UK general practices compared to usual care (UC).
Methods: We randomly allocated practices (recruited 2021-23) to receive a facilitated implementation strategy targeting organisational priorities, clinicians’ skills and patient needs or to UC. We used routine data to assess between-group difference in proportion with unscheduled asthma care/year (clinical outcome) and proportion given an action plan (implementation outcome) in all patients clinically eligible at baseline/12m/24m timepoints. Other outcomes assessed asthma care, prescribing and symptom control.
Results: We randomised 144 practices (73 IMP, 71 UC: Attrition 4 IMP; 3 UC) and included 28,488 (IMP) and 22,847 (UC) patients in the analysis. Practice/patient baseline characteristics were similar between groups and reflected known UK demographics. Overall fidelity to delivery of the strategy was good. In both groups, unscheduled care increased from a low ‘pandemic’ baseline of 17.3%; action plan provision increased in line with English financial policy incentives. There were no statistically significant differences at 24m in proportion with ≥1 unscheduled care event (IMP: 23.6% vs UC 22.6%, OR 1.06 (95%CI: 0.93, 1.21) p=0.33) or proportion given an action plan (IMP: 84.0% vs UC: 84.1%, OR 1.05 (95%CI: 0.76, 1.45) p=0.75) or other outcomes.
Conclusion: In these low-risk patients, we were unable to demonstrate any impact from the IMP2ART strategy. Our experience highlights the pivotal role of context and prioritisation at the level of health systems policy.
Funding: NIHR RP-PG-1016-20008. ISRCTN 15448074