Preventing and Lessening Exacerbations of Asthma in School-age children Associated with a New Term: The PLEASANT Trial

Problem

Background: Asthma episodes and deaths are known to be seasonal. A number of reports have shown peaks in asthma episodes in school-aged children associated with the return to school following the summer vacation. A drop in prescription collection in August has been observed which is associated with an increase in the number of unscheduled medical contacts after the return to school in September. Aim: The aim of the study was to assess if an NHS delivered public health intervention reduced the number of unscheduled medical contacts after the school return in September.

Approach

Method:Design: Cluster randomised trial with health economic analysis.Setting: Primary care. Participants: School aged children aged 5-16 with asthmaIntervention: A letter sent, from the GP to parents/carers of school-aged children with asthma, prior to the start of school summer holidays, reminding them of the importance of taking their medication and to ensure they have sufficient medication prior to the start of the new school year (September). Control group: Usual care.

Findings

Results: In terms of unscheduled contacts in September there is no evidence of effect. Among children aged 5-16 the odds-ratio was 1.11 (95% CI 0.97 to 1.27) against the intervention. The intervention did increase the proportion of children collecting a prescription in August (odds-ratio 1.46; 95% CI 1.29 to 1.66) as well as increasing scheduled contacts in the same month. For the wider time intervals (Sep-Dec 2013 and Sep-Aug 2014) there is weak evidence of the intervention reducing contacts. The economic analysis estimated a high probability that the intervention was cost saving. There was no increase in quality-adjusted life-years.

Consequences

Conclusions: The intervention did not reduce unscheduled care in September although it succeeded in increasing the proportion of children collecting prescriptions as well as increasing scheduled contacts in August. The intervention had a favourable impact on costs but did not demonstrate any impact on quality-adjusted life-years. The intervention could be implemented by GPs who wish to increase scheduled care or NHS clinical commissioning groups in areas with high rates of asthma.