An exploratory, pragmatic, cluster randomised trial of practice nurse training in the use of asthma action plans

INTRODUCTION:
To investigate the feasibility of improving asthma management - in particular, the implementation of individualised asthma action plans (AAPs) for poorly-controlled adult asthma patients - by providing training in asthma-focused clinical and communication skills for practice nurses who deliver asthma clinics.
METHODS:
A pragmatic, cluster randomised trial with an intervention (an interactive seminar) delivered at practice level (n=13 practices; 6=intervention, 7=control). The impact of the intervention was assessed against patient outcomes: routinely available asthma outcome measures (beta2-agonist prescription rate and number of oral steroid courses) for asthma patients identified as being poorly-controlled from practice records; and questionnaire data - Mini Asthma Quality of Life Questionnaire (AQLQ) and the Asthma Control Questionnaire (ACQ) - from a subset of consenting patients. Data was collected at baseline and at 6-month follow-up. ANALYSISs: Routine data was analysed for 629 patients. 236 (37%) of these patients consented to provide questionnaire data at baseline, with 75% returning questionnaires at follow-up. After adjustment for baseline and practice, there was a significant difference at followup between intervention and control practices on the Mini AQLQ only (p=0.03). Estimates for subsequent sample sizes to inform future trials of asthma training were identified.
CONCLUSION:
Training designed to support practice nurses in implementing individualised AAPs impacted on one patient outcome only. This disappointing outcome may have been due to many different factors such as outcome measure limitations, data collection problems, and underestimating the complexity of supporting practice nurses in behaviour change.