Asthma UK estimates that 5 million people in the UK have asthma; with good management most should be symptom-free most of the time. Despite this 60,000 people are admitted to hospital with asthma each year; many more attend their GP for emergency care. 1,200 people die from asthma each year – many of these deaths are preventable.  

Supported self-management, including engaging in the discussions around a personal asthma action plan, helps people adjust treatment in response to worsening symptoms, improves day-to-day asthma control and reduces the risk of asthma attacks. However, fewer than a quarter of people replying to an Asthma UK websurvey said they had an action plan. 

We aim to promote a major advance in how asthma is managed in UK primary care so that fewer people have badly controlled asthma. To do this, we need to influence the organisation of primary care asthma management, the skills of healthcare professionals and resources for patients.

In our preliminary work, people with asthma told us how habits, experience and professional advice helped them manage their asthma.  General practitioners, nurses and staff explained how they organise asthma care in their practices and discussed the best ways of fitting supported self-management into their routines.  Nurses discuss self-management within routine reviews, but lack of time is a problem.  They suggested that technological solutions (such as templates; digital action plans) would be useful, but must integrate with their computer systems.

We will now:

1. Prepare and try out a new integrated approach to help practices implement supported asthma self-management, incorporating:

• Organisational strategies to promote change (e.g. audit/feedback, improved computer templates)
• tailored patient resources (e.g. tailored paper/electronic action plans, asthma-relevant information)
• Behavior-change training for nurses/doctors/staff to develop skills 

2. Test the approach in a nationwide study.

We will recruit 144 general practices and assign them by chance to either receive the new approach to asthma care or continue with their usual care. A facilitator will visit intervention practices over a year and discuss with them the best strategies for supporting self-management in their practice. 

One year after the new strategy has been introduced into practices we will use anonymous data from practice electronic records to assess benefit by measuring how many people needed emergency care for an asthma attack and the cost of providing supported self-management. We will send questionnaires to people with asthma to ask if they have an action plan and measure their asthma control, and interview professionals and patients to help us understand how and why the strategy worked or didn’t.

If successful our strategy and the on-line educational package, experienced facilitators, digital action plans, and review templates, will be immediately ready for roll-out to benefit people with asthma and the NHS

IMP²ART is an NIHR funded programme of work and a flagship project of the Asthma UK Centre for Applied Research network of 19 universities from around the UK.

AUKCAR website 

Background

Supported self-management, which includes providing Personal Asthma Action Plans, helps people with asthma adjust their treatment in response to changes in symptoms. This improves day-to-day asthma control and reduces the risk of asthma attacks and time off work/school.

However, for many reasons, supported self-management can be difficult to implement in routine clinical practice: fewer than a quarter of people replying to an Asthma UK web-survey owned an action plan.

Aim

IMP²ART aims to help general practices embed supported self-management into routine asthma care.

Previous work

We have previously reviewed existing research on self-management of asthma. We determined that there are three key components to successful self-management:

1. Patient education
2. Professional training
3. Organisational support

Each component is rarely effective in isolation. We call this ‘whole systems’ approach, that addresses all three aspects, ‘supported self-management’.

In our preliminary IMP²ART work we explored the best way to ensure the three components of supported self-management are implemented in general practices across the United Kingdom.

Patients told us that they learn over time how to self-manage. Habits form around frequently performed behaviours; experience and self-management advice informs less common tasks. Suggested initiatives included improving access to care from a trusted professional, and using technology.

General practitioners, nurses and staff told us how they organise asthma care in their practices and discussed the best ways of fitting supported self-management into their routines. They told us that nurses provide self-management support within routine reviews, and that lack of time was a problem. They suggested that technological solutions (such as templates, digital action plans) would be useful but needed to integrate with their computer systems.

Current work

In the current IMP²ART work we are going to develop, refine and test an appropriate implementation strategy to help general practices across the UK to embed supported self-management into routine asthma care. This will include:

• Developing effective resources to support patients
• Providing in-house and online training for professionals
• Helping practices to change their organisation to prioritise supported self-management

Following the development of the implementation strategy, we will test the strategy in a UK-wide trial.

Principal Investigators

Co-Applicants 

Research Team

Asthma UK Centre for Applied Research

Usher Institute of Population Health Sciences and Informatics

Doorway 3, Medical School

Teviot Place

Edinburgh, EH8 9AG

IMP2ART@ed.ac.uk