{
  "abstract": "Background A regional trial indicated that implementing at-risk asthma registers in primary care could reduce hospital admissions. This national study assessed whether the intervention lowered asthma crisis events.Methods This cluster randomised trial involved 275 UK primary care practices. The intervention included identifying at-risk patients, staff training, a clinical decision support system alerting practice staff to patients’ at-risk status to facilitate prompt and opportunistic care, and ongoing support. Control practices continued with standard care. Patients (n=10 945) were included if identified as at-risk, unless they declined data sharing. Routine data linked across care settings captured asthma-related crisis events (hospitalisations, accident and emergency visits or death), asthma care indicators and healthcare costs over 12 months.Results Complete data were available from 185 practices (6207 patients), with exclusions mainly due to record linkage issues. Crisis events occurred in 7.2% of control versus 6.3% of intervention patients (OR 0.82, 95% CI 0.66 to 1.03, p=0.09). Individual components of the composite outcome showed similar, non-significant reductions. The use of systemic corticosteroids for asthma attacks had an OR of 1.18 (95% CI 0.99 to 1.41, p=0.07); personalised asthma action plans, OR 1.05 (95% CI 0.78 to 1.42, p=0.74); inhaler technique assessments, OR 1.13 (95% CI 0.93 to 1.38, p=0.23). Economic analysis estimated the intervention was cost-effective, with average annual National Health Service costs £306 lower in the intervention group.Conclusion This trial did not provide sufficient evidence to show that the establishment and integration of at-risk registers for asthma in primary care reduces asthma-related crisis events for people with at-risk asthma, but there was some indication of benefit.Trial registration number ISRCTN95472706.",
  "authors": [
    {
      "affiliations": [
        "Norwich Medical School, University of East Anglia, Norwich, UK",
        "Norfolk and Norwich University Hospital, Norwich, UK"
      ],
      "name": "Andrew M Wilson"
    },
    {
      "affiliations": [
        "Norwich Medical School, University of East Anglia, Norwich, UK"
      ],
      "name": "Stanley D Musgrave"
    },
    {
      "affiliations": [
        "Institute of Health Research, University of Exeter Medical School, Exeter, UK"
      ],
      "name": "Jane R Smith"
    },
    {
      "affiliations": [
        "Institute of Health Research, University of Exeter Medical School, Exeter, UK"
      ],
      "name": "Michael Noble"
    },
    {
      "affiliations": [
        "Norwich Medical School, University of East Anglia, Norwich, UK"
      ],
      "name": "Allan B Clark"
    },
    {
      "affiliations": [
        "Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK"
      ],
      "name": "Susan Stirling"
    },
    {
      "affiliations": [
        "Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK"
      ],
      "name": "Polly-Anna Ashford"
    },
    {
      "affiliations": [
        "Norwich Medical School, University of East Anglia, Norwich, UK"
      ],
      "name": "Garry Barton"
    },
    {
      "affiliations": [
        "Centre for Primary Care and Public Health, Queen Mary, University of London, London, UK",
        "Nuffield Department of Primary Care Health Sciences, University of Oxford Division of Public Health and Primary Health Care, Oxford, UK"
      ],
      "name": "Chris Griffiths"
    },
    {
      "affiliations": [
        "Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK",
        "Allergy and Respiratory Group, University of Edinburgh, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Hilary Pinnock"
    },
    {
      "affiliations": [
        "Academic Primary Care, University of Aberdeen, Aberdeen, UK",
        "Observational and Pragmatic Research Institute, Singapore"
      ],
      "name": "David B Price"
    },
    {
      "affiliations": [
        "Nuffield Department of Primary Care Health Sciences, University of Oxford Division of Public Health and Primary Health Care, Oxford, UK"
      ],
      "name": "Aziz Sheikh"
    },
    {
      "affiliations": [
        "Research and Innovation, Asthma and Lung, London, UK"
      ],
      "name": "Samantha Walker"
    }
  ],
  "title": "At-risk registers integrated into primary care to stop asthma crises in the UK: cluster randomised controlled trial with economic evaluation",
  "uid": "312defc6-88d5-5a3d-abab-571e31bab5b8"
}