Project: ARRISA-UK

At-Risk Registers Integrated into primary care to Stop Asthma crises in the UK

ARRISA-UK is a randomised controlled trial of GP practice staff training and high risk patient identification and flagging to reduce the occurrence of severe asthma related events.

Preventable hospital admissions

Unfortunately, far too many patients with asthma are admitted to hospital (approximately 72,000) or die (approximately 1150) unnecessarily in the UK every year.

We have excellent drugs available for asthma and clear advice on prescribing them that should allow asthma to be controlled in most patients.

It is known that certain asthma patients are at greater risk of being admitted or dying than others and that targeting intensive support and care to these patients improves their health.

Flagging people at risk – and learning how to help

We have undertaken a study that identified ‘at-risk’ patients within GP practices and used computer-based systems to create pop-up alerts when these patients contact the practice. Practice staff were trained on what to do when they see the alert.

This didn’t reduce the total number of attacks but reduced the hospital admissions as more patients appeared to receive appropriate treatment for their asthma.

Based on these promising findings we wish to undertake a nationwide study to confirm that we can improve the care of these patients without costing the NHS too much or affecting the care of other asthma patients within GP practices.

What are we doing about it?

We will identify patients who are at risk of having severe asthma attacks from GP practices in six regions within the UK, by searching their practice records for factors that predict risk of attacks.

In half of the GP practices, a pop-up alert will appear on the computerised medical notes whenever any of the ‘at-risk’ patients make contact with anyone in the practice. This alert will, for example, remind receptionists to book urgent appointments, GPs and nurses to advise patients to take their medication and follow their written asthma action plans and pharmacists to ensure patients take their medicines.

All practice staff will receive training on how to respond to the alerts, supported by web-based resources and practice study champions, with reminders at 6 weeks and 6 months.

We will use data available routinely from the GP practice and will not need to collect information directly from patients for our study.

After 12 months, we will count how many patients attended Accident and Emergency, had a hospital admission, or died due to asthma in each group.

We will also find out how many people have well controlled asthma, what medications are prescribed for asthma, how often patients attend routine appointments and if they stop smoking.

We will calculate how much this costs and whether it improves (or interferes with) the care of other patients with asthma in the practice.

We will work out which patients gain the most from our study. With their permission, we will arrange focus groups and interview for patients and staff, to discuss their thoughts about the at-risk registers and the training and how it worked in practice.

Key People

	Andrew Wilson		Gary Barton
	Lead: Preventing asthma attacks		Professor of Health Economics
	Based at: University of East Anglia		Based at: University of East Anglia
	Andrew's Profile		Gary's Profile
	Christopher Butler		Ann Caress
	Co-applicant		Co-applicant
	Based at: Cardiff University		Based at: University of Huddersfield
			Ann's Profile
	Allan Clark		Chris Griffiths
	Senior Lecturer in Medical Statistics		Centre Director Lead: Preventing asthma attacks
	Based at: University of East Anglia		Based at: Queen Mary University London
	Allan's Profile		Chris' Profile
	Stan Musgrave		Mike Noble
	Research Fellow		General Practitioner
	Based at: University of East Anglia		Acle Medical Partnership
	Stan's Profile
	Helen Painter		Hilary Pinnock
	Public and Patient Involvement Representative		Lead: Optimising management of asthma attacks, Lead: Postgraduate Training, Network Coordinator
			Based at: University of Edinburgh
			Hilary's Profile
	David Price		Aziz Sheikh
	Professor of Primary Care Respiratory Medicine		Centre Director
	Based at: University of Aberdeen		Based at: University of Edinburgh
	David's Profile		Aziz's Profile
	Jane Smith		Ann-Marie Swart
	Senior Lecturer in Primary Care		Professor of Epidemiology Director of the Norwich Clinical Trials Unit
	Based at: University of Exeter		Based at: University of East Anglia
	Jane's Profile		Ann-Marie's Profile
	Mike Thomas		Samantha Walker
	Professor of Primary Care Research		Deputy Chief Executive of Asthma UK
	Based at: University of Southampton
	Mike's Profile