IMPlementing IMProved Asthma self-management as RouTine (IMP 2 ART) in primary care: study protocol for a cluster randomised controlled implementation trial

• Published in: Current controlled trials in cardiovascular medicine 2023-04, Vol.24 (1), p.252-15, Article 252
• Main Authors: McClatchey, Kirstie, Hammersley, Vicky, Steed, Liz, Sheringham, Jessica, Marsh, Viv, Barat, Atena, Delaney, Brigitte, Hamborg, Thomas, Fitzsimmons, Deborah, Holmes, Steve, Jackson, Tracy, Ehrlich, Elisabeth, Morgan, Noelle, Saxon, Ann, Preston, Megan, Price, David, Taylor, Stephanie J C, Pinnock, Hilary
• Format: Article
• Language: English
• Subjects: Analysis; Asthma; Asthma - drug therapy; Asthma - therapy; Care and treatment; Chronic obstructive pulmonary disease; Coronaviruses; COVID-19; Diagnosis; Electronic health records; Family medicine; General Practice; Humans; IMP2ART; Intervention; Medical care, Cost of; Methods; Pandemics; Patient education; Primary care; Primary Health Care; Professionals; Protocol; Quality of Life; Randomised controlled implementation trial; Randomized Controlled Trials as Topic; Self-care, Health; Self-Management; Study Protocol; Systematic review
• ISSN: 1745-6215; 1745-6215
• DOI: 10.1186/s13063-023-07253-9

Asthma is a common long-term condition and major public health problem. Supported self-management for asthma that includes a written personalised asthma action plan, supported by regular professional review, reduces unscheduled consultations and improves asthma outcomes and quality of life. However, despite unequivocal inter/national guideline recommendations, supported self-management is poorly implemented in practice. The IMPlementing IMProved Asthma self-management as RouTine (IMP ART) implementation strategy has been developed to address this challenge. The aim of this implementation trial is to determine whether facilitated delivery of the IMP ART strategy increases the provision of asthma action plans and reduces unscheduled care in the context of routine UK primary care. IMP ART is a parallel group, cluster randomised controlled hybrid II implementation trial. One hundred forty-four general practices will be randomly assigned to either the IMP ART implementation strategy or control group. Following a facilitation workshop, implementation group practices will receive organisational resources to help them prioritise supported self-management (including audit and feedback; an IMP ART asthma review template), training for professionals and resources to support patients to self-manage their asthma. The control group will continue with usual asthma care. The primary clinical outcome is the between-group difference in unscheduled care in the second year after randomisation (i.e. between 12 and 24 months post-randomisation) assessed from routine data. Additionally, a primary implementation outcome of asthma action plan ownership at 12 months will be assessed by questionnaire to a random sub-group of people with asthma. Secondary outcomes include the number of asthma reviews conducted, prescribing outcomes (reliever medication and oral steroids), asthma symptom control, patients' confidence in self-management and professional support and resource use. A health economic analysis will assess cost-effectiveness, and a mixed methods process evaluation will explore implementation, fidelity and adaptation. The evidence for supported asthma self-management is overwhelming. This study will add to the literature regarding strategies that can effectively implement supported self-management in primary care to reduce unscheduled consultations and improve asthma outcomes and quality of life. ISRCTN15448074. Registered on 2 December 2019.