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

Kirstie McClatchey, Vicky Hammersley, Liz Steed, Jessica Sheringham, Viv Marsh, Atena Barat, Brigitte Delaney, Thomas Hamborg, Deborah Fitzsimmons Orcid Logo, Steve Holmes, Tracy Jackson, Elisabeth Ehrlich, Noelle Morgan, Ann Saxon, Megan Preston, David Price, Stephanie J. C. Taylor, Hilary Pinnock Orcid Logo, (the IMP2 ART Programme Group)

Trials, Volume: 24, Issue: 1

Swansea University Author: Deborah Fitzsimmons Orcid Logo

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DOI (Published version): 10.1186/s13063-023-07253-9

Abstract

BackgroundAsthma is a common long-term condition and major public health problem. Supported self-management for asthma that includes a written personalised asthma action plan, supported by regular professional review, reduces unscheduled consultations and improves asthma outcomes and quality of life...

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ISSN: 1745-6215
Published: Springer Science and Business Media LLC 2023
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However, despite unequivocal inter/national guideline recommendations, supported self-management is poorly implemented in practice. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) implementation strategy has been developed to address this challenge. The aim of this implementation trial is to determine whether facilitated delivery of the IMP2ART strategy increases the provision of asthma action plans and reduces unscheduled care in the context of routine UK primary care.MethodsIMP2ART is a parallel group, cluster randomised controlled hybrid II implementation trial. One hundred forty-four general practices will be randomly assigned to either the IMP2ART implementation strategy or control group. Following a facilitation workshop, implementation group practices will receive organisational resources to help them prioritise supported self-management (including audit and feedback; an IMP2ART asthma review template), training for professionals and resources to support patients to self-manage their asthma. The control group will continue with usual asthma care. The primary clinical outcome is the between-group difference in unscheduled care in the second year after randomisation (i.e. between 12 and 24 months post-randomisation) assessed from routine data. Additionally, a primary implementation outcome of asthma action plan ownership at 12 months will be assessed by questionnaire to a random sub-group of people with asthma. Secondary outcomes include the number of asthma reviews conducted, prescribing outcomes (reliever medication and oral steroids), asthma symptom control, patients&#x2019; confidence in self-management and professional support and resource use. A health economic analysis will assess cost-effectiveness, and a mixed methods process evaluation will explore implementation, fidelity and adaptation.DiscussionThe evidence for supported asthma self-management is overwhelming. This study will add to the literature regarding strategies that can effectively implement supported self-management in primary care to reduce unscheduled consultations and improve asthma outcomes and quality of life.</abstract><type>Journal Article</type><journal>Trials</journal><volume>24</volume><journalNumber>1</journalNumber><paginationStart/><paginationEnd/><publisher>Springer Science and Business Media LLC</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1745-6215</issnElectronic><keywords>Protocol, Randomised controlled implementation trial, IMP2ART, Asthma, Self-management, Primary care</keywords><publishedDay>3</publishedDay><publishedMonth>4</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-04-03</publishedDate><doi>10.1186/s13063-023-07253-9</doi><url>http://dx.doi.org/10.1186/s13063-023-07253-9</url><notes/><college>COLLEGE NANME</college><department>Health and Social Care School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HSOC</DepartmentCode><institution>Swansea University</institution><apcterm>External research funder(s) paid the OA fee (includes OA grants disbursed by the Library)</apcterm><funders>The National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research (Reference Number RP-PG-1016&#x2013;20008). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data or decision to publish. The Asthma UK Centre for Applied Research (reference Asthma UK: AC-2012&#x2013;01) funded some pre-grant work on the theoretical development of the implementation strategy. Education for Health developed the education modules and Optimum Patient Care developed the templates and audit and feedback components of the implementation strategy.</funders><projectreference>Reference Number RP-PG-1016&#x2013;20008</projectreference><lastEdited>2023-12-20T15:41:39.5290299</lastEdited><Created>2023-04-13T16:39:07.9545116</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care - Healthcare Science</level></path><authors><author><firstname>Kirstie</firstname><surname>McClatchey</surname><order>1</order></author><author><firstname>Vicky</firstname><surname>Hammersley</surname><order>2</order></author><author><firstname>Liz</firstname><surname>Steed</surname><order>3</order></author><author><firstname>Jessica</firstname><surname>Sheringham</surname><order>4</order></author><author><firstname>Viv</firstname><surname>Marsh</surname><order>5</order></author><author><firstname>Atena</firstname><surname>Barat</surname><order>6</order></author><author><firstname>Brigitte</firstname><surname>Delaney</surname><order>7</order></author><author><firstname>Thomas</firstname><surname>Hamborg</surname><order>8</order></author><author><firstname>Deborah</firstname><surname>Fitzsimmons</surname><orcid>0000-0002-7286-8410</orcid><order>9</order></author><author><firstname>Steve</firstname><surname>Holmes</surname><order>10</order></author><author><firstname>Tracy</firstname><surname>Jackson</surname><order>11</order></author><author><firstname>Elisabeth</firstname><surname>Ehrlich</surname><order>12</order></author><author><firstname>Noelle</firstname><surname>Morgan</surname><order>13</order></author><author><firstname>Ann</firstname><surname>Saxon</surname><order>14</order></author><author><firstname>Megan</firstname><surname>Preston</surname><order>15</order></author><author><firstname>David</firstname><surname>Price</surname><order>16</order></author><author><firstname>Stephanie J. 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The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2023-12-20T15:41:39.5290299 v2 63144 2023-04-13 IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care: study protocol for a cluster randomised controlled implementation trial e900d99a0977beccf607233b10c66b43 0000-0002-7286-8410 Deborah Fitzsimmons Deborah Fitzsimmons true false 2023-04-13 HSOC BackgroundAsthma is a common long-term condition and major public health problem. Supported self-management for asthma that includes a written personalised asthma action plan, supported by regular professional review, reduces unscheduled consultations and improves asthma outcomes and quality of life. However, despite unequivocal inter/national guideline recommendations, supported self-management is poorly implemented in practice. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) implementation strategy has been developed to address this challenge. The aim of this implementation trial is to determine whether facilitated delivery of the IMP2ART strategy increases the provision of asthma action plans and reduces unscheduled care in the context of routine UK primary care.MethodsIMP2ART is a parallel group, cluster randomised controlled hybrid II implementation trial. One hundred forty-four general practices will be randomly assigned to either the IMP2ART implementation strategy or control group. Following a facilitation workshop, implementation group practices will receive organisational resources to help them prioritise supported self-management (including audit and feedback; an IMP2ART asthma review template), training for professionals and resources to support patients to self-manage their asthma. The control group will continue with usual asthma care. The primary clinical outcome is the between-group difference in unscheduled care in the second year after randomisation (i.e. between 12 and 24 months post-randomisation) assessed from routine data. Additionally, a primary implementation outcome of asthma action plan ownership at 12 months will be assessed by questionnaire to a random sub-group of people with asthma. Secondary outcomes include the number of asthma reviews conducted, prescribing outcomes (reliever medication and oral steroids), asthma symptom control, patients’ confidence in self-management and professional support and resource use. A health economic analysis will assess cost-effectiveness, and a mixed methods process evaluation will explore implementation, fidelity and adaptation.DiscussionThe evidence for supported asthma self-management is overwhelming. This study will add to the literature regarding strategies that can effectively implement supported self-management in primary care to reduce unscheduled consultations and improve asthma outcomes and quality of life. Journal Article Trials 24 1 Springer Science and Business Media LLC 1745-6215 Protocol, Randomised controlled implementation trial, IMP2ART, Asthma, Self-management, Primary care 3 4 2023 2023-04-03 10.1186/s13063-023-07253-9 http://dx.doi.org/10.1186/s13063-023-07253-9 COLLEGE NANME Health and Social Care School COLLEGE CODE HSOC Swansea University External research funder(s) paid the OA fee (includes OA grants disbursed by the Library) The National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research (Reference Number 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. The funder had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data or decision to publish. The Asthma UK Centre for Applied Research (reference Asthma UK: AC-2012–01) funded some pre-grant work on the theoretical development of the implementation strategy. Education for Health developed the education modules and Optimum Patient Care developed the templates and audit and feedback components of the implementation strategy. Reference Number RP-PG-1016–20008 2023-12-20T15:41:39.5290299 2023-04-13T16:39:07.9545116 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Healthcare Science Kirstie McClatchey 1 Vicky Hammersley 2 Liz Steed 3 Jessica Sheringham 4 Viv Marsh 5 Atena Barat 6 Brigitte Delaney 7 Thomas Hamborg 8 Deborah Fitzsimmons 0000-0002-7286-8410 9 Steve Holmes 10 Tracy Jackson 11 Elisabeth Ehrlich 12 Noelle Morgan 13 Ann Saxon 14 Megan Preston 15 David Price 16 Stephanie J. C. Taylor 17 Hilary Pinnock 0000-0002-5976-8386 18 (the IMP2 ART Programme Group) 19 63144__27432__359af35392bf433c91091ca94c9d2d3f.pdf 63144.pdf 2023-05-11T11:55:58.6540342 Output 2045804 application/pdf Version of Record true Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. true eng http://creativecommons.org/licenses/by/4.0/
title IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care: study protocol for a cluster randomised controlled implementation trial
spellingShingle IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care: study protocol for a cluster randomised controlled implementation trial
Deborah Fitzsimmons
title_short IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care: study protocol for a cluster randomised controlled implementation trial
title_full IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care: study protocol for a cluster randomised controlled implementation trial
title_fullStr IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care: study protocol for a cluster randomised controlled implementation trial
title_full_unstemmed IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care: study protocol for a cluster randomised controlled implementation trial
title_sort IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care: study protocol for a cluster randomised controlled implementation trial
author_id_str_mv e900d99a0977beccf607233b10c66b43
author_id_fullname_str_mv e900d99a0977beccf607233b10c66b43_***_Deborah Fitzsimmons
author Deborah Fitzsimmons
author2 Kirstie McClatchey
Vicky Hammersley
Liz Steed
Jessica Sheringham
Viv Marsh
Atena Barat
Brigitte Delaney
Thomas Hamborg
Deborah Fitzsimmons
Steve Holmes
Tracy Jackson
Elisabeth Ehrlich
Noelle Morgan
Ann Saxon
Megan Preston
David Price
Stephanie J. C. Taylor
Hilary Pinnock
(the IMP2 ART Programme Group)
format Journal article
container_title Trials
container_volume 24
container_issue 1
publishDate 2023
institution Swansea University
issn 1745-6215
doi_str_mv 10.1186/s13063-023-07253-9
publisher Springer Science and Business Media LLC
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Healthcare Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Healthcare Science
url http://dx.doi.org/10.1186/s13063-023-07253-9
document_store_str 1
active_str 0
description BackgroundAsthma is a common long-term condition and major public health problem. Supported self-management for asthma that includes a written personalised asthma action plan, supported by regular professional review, reduces unscheduled consultations and improves asthma outcomes and quality of life. However, despite unequivocal inter/national guideline recommendations, supported self-management is poorly implemented in practice. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) implementation strategy has been developed to address this challenge. The aim of this implementation trial is to determine whether facilitated delivery of the IMP2ART strategy increases the provision of asthma action plans and reduces unscheduled care in the context of routine UK primary care.MethodsIMP2ART is a parallel group, cluster randomised controlled hybrid II implementation trial. One hundred forty-four general practices will be randomly assigned to either the IMP2ART implementation strategy or control group. Following a facilitation workshop, implementation group practices will receive organisational resources to help them prioritise supported self-management (including audit and feedback; an IMP2ART asthma review template), training for professionals and resources to support patients to self-manage their asthma. The control group will continue with usual asthma care. The primary clinical outcome is the between-group difference in unscheduled care in the second year after randomisation (i.e. between 12 and 24 months post-randomisation) assessed from routine data. Additionally, a primary implementation outcome of asthma action plan ownership at 12 months will be assessed by questionnaire to a random sub-group of people with asthma. Secondary outcomes include the number of asthma reviews conducted, prescribing outcomes (reliever medication and oral steroids), asthma symptom control, patients’ confidence in self-management and professional support and resource use. A health economic analysis will assess cost-effectiveness, and a mixed methods process evaluation will explore implementation, fidelity and adaptation.DiscussionThe evidence for supported asthma self-management is overwhelming. This study will add to the literature regarding strategies that can effectively implement supported self-management in primary care to reduce unscheduled consultations and improve asthma outcomes and quality of life.
published_date 2023-04-03T20:21:20Z
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