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

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

doi:10.1136/thoraxjnl-2012-202093

Cited by 36 publications

(61 citation statements)

References 29 publications

(29 reference statements)

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“…4,12,13 This study contrasts with the findings of other research that reported decreased emergency admission with increasing distance from hospital and with higher deprivation. [31][32][33] The study differs from those in that a multilevel analysis was used clustering at the primary care trust level.…”

Section: Comparison With Existing Literaturecontrasting

confidence: 56%

“…4 Two English studies that targeted asthma patients at high risk of adverse outcomes by flagging the medical record and training staff to improve access have reported reduced hospital admission, as well as improved quality of care. 12,13 Increased emergency asthma admissions have been reported to be associated with decreased access to health care in North Carolina in the US.…”

mentioning

confidence: 99%

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Emergency hospital admissions for asthma and access to primary care: cross-sectional analysis

Fleetcroft¹,

Noble²,

Martin³

et al. 2016

Br J Gen Pract

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Background: Access to general practices may be an important determinant of emergency admissions for asthma, as early treatment of exacerbations has been shown to prevent deterioration. Aim: To determine whether access to primary care is associated with emergency admissions for asthma. Design and Setting: Cross-sectional analysis of data from English practices in 2010/11. Method: Negative binomial regression was used to explore the associations between emergency admissions for asthma and seven measures of patient-reported access to general practice services taken from GP Patient Survey, controlled for the characteristics of practice populations. Incidence rate ratios (IRR) were calculated for each association. Results: 7806 (95%) of practices had data for all variables. There were 3,134,106 patients with asthma, and there were 55,570 emergency admissions with asthma. Admission rates were lower in practices with a higher composite access score (adjusted IRR for 10% change in variable 0.679 (95%CI 0.665 to 0.708)). Admissions were higher in those practices with higher proportions of the practice population who were white, and in practices with lower performance in the Quality and Outcomes Framework indicator ‘asthma review in past 15 months’ (Asthma 6). Assuming these associations were causal, a higher access score of 10% was associated with a decrease of 17,837 admissions per year for these practices. Conclusion: Practices with higher patient reported access had lower rates of emergency admissions for asthma. Policy makers should consider improving access to primary care as one potential way to help prevent emergency hospital admissions for asthma

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Section: Comparison With Existing Literaturecontrasting

confidence: 56%

mentioning

confidence: 99%

Emergency hospital admissions for asthma and access to primary care: cross-sectional analysis

Fleetcroft¹,

Noble²,

Martin³

et al. 2016

Br J Gen Pract

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“…13,14 Most recently, the ARISSA study used "asthma risk registers" to help outpatient practices identify and focus on their highest-risk patients. 15 Many of these programs have seen positive outcomes, such as increased adherence to controller medications and more symptom-free days. However, few have significantly reduced asthma-related ED visits.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12][13][14][15] Few have significantly reduced ED utilization. This leads us to ask: are there reasons for asthma-related ED use that prior interventions have not addressed?…”

mentioning

confidence: 99%

“No Other Choice”: Reasons for Emergency Department Utilization Among Urban Adults With Acute Asthma

Lawson

Carroll

Gonzalez

et al. 2014

Academic Emergency Medicine

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Objectives: Asthma is considered "ambulatory care-sensitive," yet emergency department (ED) visits remain common. Few studies have examined how ED asthma patients choose their sites of urgent care. The authors explored reasons for asthma-related ED use among adults.Methods: From May to September 2012, semistructured qualitative interviews were conducted with a convenience sample of patients visiting a high-volume urban ED for asthma. A piloted interview guide was used; it had open-ended questions derived from clinical experience and a focus group of asthmatic adults who frequently use the ED for care. Interviews were conducted until theme saturation was reached. Interview transcripts and field notes were entered into NVivo 10 and double-coded, using an iterative process to identify patterns of responses, ensure reliability, examine discrepancies, and achieve consensus through content analysis.

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“…There is proof of concept in adult populations that primary care records can be used to alert primary care staff to patients who are at high risk of asthma attacks,37 although differences in lifestyle (eg, smoking) and comorbidities (eg, COPD or diagnosed depression) mean that this needs to be replicated in children. “Avoiding hospital admissions”, a document by the King’ Fund, described an educational intervention to parent and child in accident and ED might reduce a child’s risk of future admissions by 20%;38 might this approach work in the primary care setting?…”

Section: Introductionmentioning

confidence: 99%

Predicting and reducing risk of exacerbations in children with asthma in the primary care setting: current perspectives

Turner

2016

POR

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Childhood asthma is a very common condition in western countries and is becoming more prevalent worldwide. Asthma attacks (or exacerbations) affect the quality of life for child and parent, can rarely result in death, and also come at a cost for health care providers and the economy. The aims of this review were to 1) describe the burden of asthma exacerbations, 2) describe factors that might predict a child at increased risk of having an asthma attack, and 3) explore what interventions might be delivered in primary care to reduce the risk of a child having an asthma attack. Asthma attacks are more common in younger children and those with more severe asthma, although prevalence varies between countries. Many factors are associated with asthma attacks including environmental exposures, patient–clinician relationship, and patient factors. Currently, the best predictor of an asthma attack is a history of an attack in the previous 12 months, and the more attacks, the greater the risk. Looking ahead, it is likely that surveillance of routinely collected primary care data can be used to identify an individual at increased risk. Stratified (or personalized) treatment, which might involve physiological monitoring and genetic analysis, offers the potential to reduce an individual’s risk of asthma attack. Whatever the future holds, the relationship between patient and clinician will remain central to asthma management.

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

Cited by 36 publications

References 29 publications

Emergency hospital admissions for asthma and access to primary care: cross-sectional analysis

Emergency hospital admissions for asthma and access to primary care: cross-sectional analysis

“No Other Choice”: Reasons for Emergency Department Utilization Among Urban Adults With Acute Asthma

Predicting and reducing risk of exacerbations in children with asthma in the primary care setting: current perspectives

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