IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care: internal pilot for a cluster randomised controlled trial

Conference: 
SAPC ASM 2022 - UCLan
Talk Code: 
P1.2B.2
Presenter: 
Steph Taylor
Co-authors: 
Kirstie McClatchey, Jessica Sheringham, Atena Barat, Brigitte Delaney, Barbara Searle, Viv Marsh, Vicky Hammersley, Liz Steed, Stephanie Taylor, Hilary Pinnock
Author institutions: 
The University of Edinburgh, University College London, Queen Mary University of London, The University of Sheffield, Queen Mary University of London, The University of Edinburgh, The University of Edinburgh, Queen Mary University of London, Queen Mary University of London, The University of Edinburgh

Problem

Asthma results in 6.3 million primary care consultations in the United Kingdom (UK) each year, and supported asthma self-management (including regular clinical review, patient education, and asthma action plan provision) can improve asthma control and quality of life. However, despite the evidence, supported self-management for asthma, in particular action plan provision, is poorly implemented in practice. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) programme is a multidisciplinary and theoretically-informed strategy to improve the implementation of supported self-management in primary care. The strategy includes 1) patient resources to support self-management (asthma review invitation letters, patient website) 2) professional asthma self-management education for practice staff 3) organisational strategies (asthma review template, audit and feedback). This pilot, internal to a cluster randomised controlled trial (RCT), aimed to test trial processes and recruitment feasibility, and to understand practices’ likely engagement with the IMP2ART strategy.

Approach

A mixed-method pilot was conducted in 12 general practices (May-September 2021). Practices were randomised to the IMP2ART implementation arm (n=6), or usual care control (n=6). Recruitment and set-up processes were monitored, with quantitative data analysed on key aspects of the IMP2ART delivery (IMP2ART asthma review template uploads, audit and feedback reports sent, IMP2ART workshops held) and practice response (website views, education module completion). 10 qualitative interviews were conducted with implementation arm staff (general practitioners; nurses; practice managers) and IMP2ART facilitators (who delivered the strategy). Interviews were audio-recorded and analysed using framework analysis.

Findings

We successfully recruited 12 practices to the study. One control practice withdrew (due to a change in practice approach to data governance). We delivered the IMP2ART strategy largely as planned; the IMP2ART asthma review template was successfully uploaded, the annual asthma audit report was sent, and practice workshops were held in all implementation practices (attendance ranged from 7-31 clinical and administrative staff). There were, however, minor delivery delays for some monthly audit and feedback reports. Practice response analysis indicated ≈450 unique page views on the patient resource website, and 100% of practices completed the team education module. Interview data were largely positive, with examples of how practices were using IMP2ART.

Consequences

The IMP2ART trial processes were successful and required only minor changes. Practices engaged with the implementation strategy and its resources, suggesting the IMP2ART strategy is acceptable and feasible. IMP2ART is now being tested in a UK-wide cluster-RCT.

Submitted by: 
Kirstie McClatchey
Funding acknowledgement: 
Funding: NIHR PGfAR (RP-PG-1016-20008).The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.