The at-risk registers in severe asthma (ARRISA) study: a cluster-randomised controlled trial examining effectiveness and costs in primary care

Jane Rebecca Smith, Michael J Noble, Stanley Musgrave, Jamie Murdoch, Gill M Price, Garry R Barton, Jennifer Windley, Richard Holland, Brian D W Harrison, Amanda Howe, David B Price, Ian Harvey, Andrew M Wilson

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

BACKGROUND:
Patients at risk of severe exacerbations contribute disproportionally to asthma mortality, morbidity and costs. We evaluated the effectiveness and costs of using 'asthma risk registers' for these patients in primary care.
METHODS:
In a cluster-randomised trial, 29 primary care practices identified 911 at-risk asthma patients using British asthma guideline criteria (severe asthma plus adverse psychosocial characteristics). Intervention practices added electronic alerts to identified patients' records to flag their at-risk status and received practice-based training about using the alerts to improve patient access and opportunistic management. Control practices continued routine care. Numbers of patients experiencing the primary outcome of a moderate-severe exacerbation (resulting in death, hospitalisation, accident and emergency attendance, out-of-hours contact, or a course/boost in oral prednisolone for asthma), other healthcare and medication usage, and costs over 1 year were derived from practice-based records.
RESULTS:
There was no significant effect on exacerbations (control: 46.5%; intervention: 53.6%, OR, 95% CI 1.30, 0.93 to 1.80). However, this composite outcome masked relative reductions in intervention patients experiencing hospitalisations (OR 0.50, 95% CI 0.26 to 0.94), accident and emergency (OR 0.74, 95% CI 0.42 to 1.31) and out-of-hours contacts (OR 0.79, 95% CI 0.45 to 1.37); and a relative increase in prednisolone prescription for exacerbations (OR 1.31, 95% CI 0.92 to 1.85). Furthermore, prescription of nebulised short-acting ß-agonists reduced and long-acting ß-agonists increased for intervention relative to control patients. The adjusted mean per patient healthcare cost was £138.21 lower (p=0.837) among intervention practices.
CONCLUSION:
Using asthma risk registers in primary care did not reduce treated exacerbations, but reduced hospitalisations and increased prescriptions of recommended preventative therapies without increasing costs.
Original languageEnglish
Pages (from-to)1052-1060
Number of pages9
JournalThorax
Volume67
Issue number12
Early online date31 Aug 2012
DOIs
Publication statusPublished - Dec 2012

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Cost-Benefit Analysis
Primary Health Care
Asthma
Randomized Controlled Trials
Prescriptions
Hospitalization
Prednisolone
Costs and Cost Analysis
Accidents
Emergencies
Health Care Costs
Guidelines
Morbidity
Delivery of Health Care
Mortality

Keywords

  • Asthma

Cite this

Smith, J. R., Noble, M. J., Musgrave, S., Murdoch, J., Price, G. M., Barton, G. R., ... Wilson, A. M. (2012). The at-risk registers in severe asthma (ARRISA) study: a cluster-randomised controlled trial examining effectiveness and costs in primary care. Thorax, 67(12), 1052-1060. https://doi.org/10.1136/thoraxjnl-2012-202093

The at-risk registers in severe asthma (ARRISA) study : a cluster-randomised controlled trial examining effectiveness and costs in primary care. / Smith, Jane Rebecca; Noble, Michael J; Musgrave, Stanley; Murdoch, Jamie; Price, Gill M; Barton, Garry R; Windley, Jennifer; Holland, Richard; Harrison, Brian D W; Howe, Amanda; Price, David B; Harvey, Ian; Wilson, Andrew M.

In: Thorax, Vol. 67, No. 12, 12.2012, p. 1052-1060.

Research output: Contribution to journalArticle

Smith, JR, Noble, MJ, Musgrave, S, Murdoch, J, Price, GM, Barton, GR, Windley, J, Holland, R, Harrison, BDW, Howe, A, Price, DB, Harvey, I & Wilson, AM 2012, 'The at-risk registers in severe asthma (ARRISA) study: a cluster-randomised controlled trial examining effectiveness and costs in primary care', Thorax, vol. 67, no. 12, pp. 1052-1060. https://doi.org/10.1136/thoraxjnl-2012-202093
Smith, Jane Rebecca ; Noble, Michael J ; Musgrave, Stanley ; Murdoch, Jamie ; Price, Gill M ; Barton, Garry R ; Windley, Jennifer ; Holland, Richard ; Harrison, Brian D W ; Howe, Amanda ; Price, David B ; Harvey, Ian ; Wilson, Andrew M. / The at-risk registers in severe asthma (ARRISA) study : a cluster-randomised controlled trial examining effectiveness and costs in primary care. In: Thorax. 2012 ; Vol. 67, No. 12. pp. 1052-1060.
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AU - Murdoch, Jamie

AU - Price, Gill M

AU - Barton, Garry R

AU - Windley, Jennifer

AU - Holland, Richard

AU - Harrison, Brian D W

AU - Howe, Amanda

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AU - Harvey, Ian

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N2 - BACKGROUND:Patients at risk of severe exacerbations contribute disproportionally to asthma mortality, morbidity and costs. We evaluated the effectiveness and costs of using 'asthma risk registers' for these patients in primary care.METHODS:In a cluster-randomised trial, 29 primary care practices identified 911 at-risk asthma patients using British asthma guideline criteria (severe asthma plus adverse psychosocial characteristics). Intervention practices added electronic alerts to identified patients' records to flag their at-risk status and received practice-based training about using the alerts to improve patient access and opportunistic management. Control practices continued routine care. Numbers of patients experiencing the primary outcome of a moderate-severe exacerbation (resulting in death, hospitalisation, accident and emergency attendance, out-of-hours contact, or a course/boost in oral prednisolone for asthma), other healthcare and medication usage, and costs over 1 year were derived from practice-based records.RESULTS:There was no significant effect on exacerbations (control: 46.5%; intervention: 53.6%, OR, 95% CI 1.30, 0.93 to 1.80). However, this composite outcome masked relative reductions in intervention patients experiencing hospitalisations (OR 0.50, 95% CI 0.26 to 0.94), accident and emergency (OR 0.74, 95% CI 0.42 to 1.31) and out-of-hours contacts (OR 0.79, 95% CI 0.45 to 1.37); and a relative increase in prednisolone prescription for exacerbations (OR 1.31, 95% CI 0.92 to 1.85). Furthermore, prescription of nebulised short-acting ß-agonists reduced and long-acting ß-agonists increased for intervention relative to control patients. The adjusted mean per patient healthcare cost was £138.21 lower (p=0.837) among intervention practices.CONCLUSION:Using asthma risk registers in primary care did not reduce treated exacerbations, but reduced hospitalisations and increased prescriptions of recommended preventative therapies without increasing costs.

AB - BACKGROUND:Patients at risk of severe exacerbations contribute disproportionally to asthma mortality, morbidity and costs. We evaluated the effectiveness and costs of using 'asthma risk registers' for these patients in primary care.METHODS:In a cluster-randomised trial, 29 primary care practices identified 911 at-risk asthma patients using British asthma guideline criteria (severe asthma plus adverse psychosocial characteristics). Intervention practices added electronic alerts to identified patients' records to flag their at-risk status and received practice-based training about using the alerts to improve patient access and opportunistic management. Control practices continued routine care. Numbers of patients experiencing the primary outcome of a moderate-severe exacerbation (resulting in death, hospitalisation, accident and emergency attendance, out-of-hours contact, or a course/boost in oral prednisolone for asthma), other healthcare and medication usage, and costs over 1 year were derived from practice-based records.RESULTS:There was no significant effect on exacerbations (control: 46.5%; intervention: 53.6%, OR, 95% CI 1.30, 0.93 to 1.80). However, this composite outcome masked relative reductions in intervention patients experiencing hospitalisations (OR 0.50, 95% CI 0.26 to 0.94), accident and emergency (OR 0.74, 95% CI 0.42 to 1.31) and out-of-hours contacts (OR 0.79, 95% CI 0.45 to 1.37); and a relative increase in prednisolone prescription for exacerbations (OR 1.31, 95% CI 0.92 to 1.85). Furthermore, prescription of nebulised short-acting ß-agonists reduced and long-acting ß-agonists increased for intervention relative to control patients. The adjusted mean per patient healthcare cost was £138.21 lower (p=0.837) among intervention practices.CONCLUSION:Using asthma risk registers in primary care did not reduce treated exacerbations, but reduced hospitalisations and increased prescriptions of recommended preventative therapies without increasing costs.

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DO - 10.1136/thoraxjnl-2012-202093

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JO - Thorax

JF - Thorax

SN - 0040-6376

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ER -