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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)

BMJ 2004; 328 doi: (Published 15 January 2004) Cite this as: BMJ 2004;328:144
  1. Chris Griffiths (c.j.griffiths{at}, professor of primary care1,
  2. Gill Foster, research officer1,
  3. Neil Barnes, professor of respiratory pharmacology2,
  4. Sandra Eldridge, senior lecturer in medical statistics1,
  5. Helen Tate, statistician1,
  6. Shamoly Begum, research assistant1,
  7. Mo Wiggins, specialist asthma nurse2,
  8. Carolyn Dawson, specialist asthma nurse2,
  9. Anna Eleri Livingstone, general practitioner3,
  10. Mike Chambers, health economist4,
  11. Tim Coats, senior lecturer in accident and emergency medicine5,
  12. Roger Harris, consultant paediatrician5,
  13. Gene S Feder, professor of primary care research and development (c.j.griffiths{at}
  1. 1Centre 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. 2Department of Respiratory Medicine, London Chest Hospital, London E2 9JX
  3. 3Gill Street Health Centre, London E14 8HQ
  4. 4Amersham Health, Little Chalfont, Bucks HP7 9NA,
  5. 5Royal London Hospital, London E1 1BB
  1. Correspondence to: C Griffiths


    Objective To determine whether asthma specialist nurses, using a liaison model of care, reduce unscheduled care in a deprived multiethnic 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 attending hospital or the general practitioner out of hours service with acute asthma; 164 (50%) were South Asian patients, 108 (34%) were white patients, and 52 (16%) were from other, largely African and Afro-Caribbean, ethnicities.

    Intervention Patient review in a nurse led clinic and liaison with general practitioners and practice nurses comprising educational outreach, promotion of guidelines for high risk asthma, and ongoing clinical support. Control practices received a visit promoting standard asthma guidelines; control patients were checked for inhaler technique.

    Main outcome measures Percentage of participants receiving unscheduled care for acute asthma over one year and time to first unscheduled attendance.

    Results Primary outcome data were available for 319 of 324 (98%) participants. Intervention delayed time to first attendance with acute asthma (hazard ratio 0.73, 95% confidence interval 0.54 to 1.00; median 194 days for intervention and 126 days for control) and reduced the percentage of participants attending with acute asthma (58% (101/174) v 68% (99/145); odds ratio 0.62, 0.38 to 1.01). In analyses of prespecified subgroups the difference in effect on ethnic groups was not significant, but results were consistent with greater benefit for white patients than for South Asian patients or those from other ethnic groups.

    Conclusion Asthma specialist nurses using a liaison model of care reduced unscheduled care for asthma in a deprived multiethnic health district. Ethnic groups may not benefit equally from specialist nurse intervention.


    • Contributors CG conceived the study. CG, NB, GSF, SE, and AL designed the study. GF and SB recruited and followed up the participants. MW and CD carried out the intervention. TC and RH developed recruitment. SE and HT carried out statistical analyses. CG wrote the first draft on which all commented. CG will act as guarantor for the paper

    • Funding National Asthma Campaign

    • Competing interests None declared

    • Ethical approval The study was approved by the local research ethics committee

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