A pragmatic cluster randomised controlled trial (cRCT) of an educational intervention to promote asthma prescription uptake in General Practitioner Practices

Abstract

Background: Asthma exacerbation rates in school-age children peak following the return to school after the summer break. Studies have shown a decline in prescriptions collection during August, which is followed by an increase in unscheduled visits to healthcare providers. A previous study (the PLEASANT trial) found that sending reminder letters to parents of children with asthma during the summer vacation led to a 30% increase in August prescriptions being prescribed and reduced unscheduled care visits after the return to schools in the period September to December. The intervention also resulted in an estimated cost saving of £36.07 per patient per year.

Objective: To determine if informing general practitioner (GP) practices about the PLEASANT trial intervention results leads to its implementation.

Design: A pragmatic cluster randomised trial which utilised the Clinical Practice Research Datalink (CPRD) to send the intervention and collect data.

Participants: A total of 1,326 GP practices in England, including 90,583 individuals, with 664 practices (44,708 individuals) in the intervention group and 662 practices (45,875 individuals) in the control group.

Intervention: In June 2021, the intervention practices received a letter from CPRD about the PLEASANT study findings and recommendations. The letter was sent to the asthma lead and/or practice manager via postal mail and email.

Control Arm: Usual care.

Randomisation: GP practices were stratified by practice size (decile) and randomly allocated to either the intervention or control group.

Main Outcome: The proportion of children with asthma who had a prescription for an asthma preventer medication in August and September 2021.

Results: The intervention did not significantly affect the proportion of children with asthma who had a prescription in August and September 2021 compared to the control arm. In the intervention group, 15,716 out of 44,465 children (35.3%) had a prescription issued, compared to 16,001 out of 45,559 children (35.1%) in the control group (OR 1.01; 95% CI: 0.97 to 1.04). There was also no intervention effect on the number of prescriptions uptake in the same period (IRR 1.01; 95% CI: 0.98 to 1.03). Furthermore, the letter did not reduce the number of unscheduled medical contacts after returning to school from September to December 2021 (IRR 0.99; 95% CI: 0.96 to 1.02) and all medical contacts remained unchanged (IRR 1.00; 95% CI: 0.97 to 1.02).

Conclusion: The study findings suggest that passive intervention of providing a letter to GPs did not achieve the intended outcomes. To bridge the gap between evidence and practice, alternative, more proactive strategies could be explored to address the identified issues.