Specialist nurse intervention to reduce unscheduled asthma care in a deprived multiethnic area: the east London randomised controlled trial for high risk asthma (ELECTRA)

doi:10.1136/bmj.37950.784444.EE

BMJ 2004;328:144 (17 January), doi:10.1136/bmj.37950.784444.EE (published 12 January 2004)

Primary care

Specialist nurse intervention to reduce unscheduled asthma care in a deprived multiethnic area: the east London randomised controlled trial for high risk asthma (ELECTRA)

Chris Griffiths, professor of primary care¹, Gill Foster, research officer¹, Neil Barnes, professor of respiratory pharmacology², Sandra Eldridge, senior lecturer in medical statistics¹, Helen Tate, statistician¹, Shamoly Begum, research assistant¹, Mo Wiggins, specialist asthma nurse², Carolyn Dawson, specialist asthma nurse², Anna Eleri Livingstone, general practitioner³, Mike Chambers, health economist⁴, Tim Coats, senior lecturer in accident and emergency medicine⁵, Roger Harris, consultant paediatrician⁵, Gene S Feder, professor of primary care research and development¹

¹ Centre for General Practice and Primary Care, Institute of Community Health Sciences, Barts and the London, Medical Sciences, Queen Mary's School of Medicine and Dentistry, Queen Mary, University of London E1 4NS, ² Department of Respiratory Medicine, London Chest Hospital, London E2 9JX, ³ Gill Street Health Centre, London E14 8HQ, ⁴ Amersham Health, Little Chalfont, Bucks HP7 9NA, ⁵ Royal London Hospital, London E1 1BB

Correspondence to: C Griffiths c.j.griffiths{at}qmul.ac.uk

Objective To determine whether asthma specialist nurses, usinga liaison model of care, reduce unscheduled care in a deprivedmultiethnic area.

Design Cluster randomised controlled trial.

Setting 44 general practices in two boroughs in east London.

Participants 324 people aged 4-60 years admitted to or attendinghospital or the general practitioner out of hours service withacute asthma; 164 (50%) were South Asian patients, 108 (34%)were white patients, and 52 (16%) were from other, largely Africanand Afro-Caribbean, ethnicities.

Intervention Patient review in a nurse led clinic and liaisonwith general practitioners and practice nurses comprising educationaloutreach, promotion of guidelines for high risk asthma, andongoing clinical support. Control practices received a visitpromoting standard asthma guidelines; control patients werechecked for inhaler technique.

Main outcome measures Percentage of participants receiving unscheduledcare for acute asthma over one year and time to first unscheduledattendance.

Results Primary outcome data were available for 319 of 324 (98%)participants. Intervention delayed time to first attendancewith acute asthma (hazard ratio 0.73, 95% confidence interval0.54 to 1.00; median 194 days for intervention and 126 daysfor control) and reduced the percentage of participants attendingwith acute asthma (58% (101/174) v 68% (99/145); odds ratio0.62, 0.38 to 1.01). In analyses of prespecified subgroups thedifference in effect on ethnic groups was not significant, butresults were consistent with greater benefit for white patientsthan for South Asian patients or those from other ethnic groups.

Conclusion Asthma specialist nurses using a liaison model ofcare reduced unscheduled care for asthma in a deprived multiethnichealth district. Ethnic groups may not benefit equally fromspecialist nurse intervention.

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Asthma specialist nurses reduce unscheduled care
BMJ 2004 328: 0. [Full Text]

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