Collaborations of the Center With England & Scotland

Colleagues in London and Aberdeen are examining, in two separate studies, the effect the Physician Asthma Care Training Program (PACE) has on patients in those countries.  They are enrolling health care providers and following patients over time to ascertain changes in asthma control. 

The Center for Managing Chronic Disease is collaborating, providing training and consultation.

Scotland:

Effects of Patient-Centred Asthma Education for GPs and Practice Nurses: A Randomised Controlled Trial Evaluating the Impact of Training in Self Regulation Skills on Patient Outcomes

Jennifer A. Cleland, Mandy A. D. Moffat, Christine E. Bucknal, Phil Cotton, Mike Thomas, Chris Griffith, Noreen Clark 

Evidence-based guidelines in the United Kingdom recommend helping those with asthma control their symptoms and improve their quality of life through provision of education and individualised, written action plans.  These goals reflect the need for full involvement of patient and clinician in a partnership.  The evidence that asthma morbidity remains high despite the advances in clinical treatment suggested scope for UK practitioners encouraging greater patient involvement in their asthma management.  Training professionals to help a range of patients with individual disease characteristics, personal attributes and lifestyles may be an important factor in asthma management. 

The PACE programme is a theory based training package that combines teaching on clinical guidelines with specific, theory-based communication skills.  It has been effectively targeted at children with poorly-controlled asthma (Clark et al. Pediatrics 2000). We wished to assess the effectiveness of PACE in a UK primary care population; in adult patients with asthma; and with nurses given a) the paucity of evidence on whether interventions of this nature might be applicable to providers other than doctors and b) the majority of UK asthma care is delivered in nurse-led clinics.  

The design of the study is a two-centred (Glasgow and Aberdeen, both Scotland) prospective clustered randomised control trial over three years. Sixteen practices were recruited to the study.  Patient recruitment is nearly complete.

We are using various outcome measures - patient questionnaires such as the ACQ (Asthma Control), mini AQLQ (Asthma Quality of Life), and MISS (Satisfaction with consultation), as well as routine healthcare data (e.g., number of asthma related consultations).  Patient questionnaire data is collected at  three time points: immediately after recruitment (shortly after consulting with GP or PN), 3 months, and 12 months.  The impact of training on the healthcare professionals was measured using a Theory of Planned Behaviour (TPB) questionnaire, specifically designed for the PACE programme.

The PACE programme was adapted for Scotland ("tartanized") and targeted at those primary care clinicians (General Practitioners and Practice Nurses) who manage the majority of asthma care.  Remaining true to the theoretical underpinning of the original training package, tools were developed for the UK context and for adults with uncontrolled asthma.  Training consisted of two 2.5 hour sessions approximately a fortnight apart and consisted of small mixed groups (GPs and PNs). The first session included short presentations with small group discussion, video footage of skills being used and homework being given.  The second session was mainly discussion regarding skills practice, case studies, and video footage to reinforce some of the skills.  Video clips included Practice Nurse sessions and GP consultations.  The training has been delivered and patient recruitment is nearly completed.  In terms of impact on training on the healthcare professionals, the TPB questionnaire was administered to those randomised to the intervention arm (8 GPs and 8 PNs).  Descriptive analysis highlighted a change in intention to carry out key behaviors and increased knowledge regarding communication skills and asthma management.  Patient recruitment soon will be closing and we hope to have the results from the immediate impact that training has had on patient outcomes shortly thereafter.  The short term and longer term follow up will be completed over 14 months.  

For more information, contact Center Associate Dr. Jen Cleland at jen.cleland@abdn.ac.uk

England: 

The OEDIPUS trial: Outcomes of Education in asthma patients of South Asian origin

A project at Barts and The London Queen Mary's School of Medicine and Dentistry is assessing a comprehensive intervention to enhance care and education provided in general practice clinics to asthma patients of South Asian origin. The patient population in East London comprises a number of ethnic groups but predominantly South Asian, including Bangladeshi, Indian, Pakistani and Sri Lankan. The majority of residents are low income.

South Asian patients are recruited to the study after attending the hospital or out of hours services with an asthma attack. The intervention comprises specialist nurse self management advice given in the outpatients setting; an adaptation of Physician Asthma Care Education (PACE) developed at the Center for Managing Chronic Disease for primary care doctors and nurses, and improved follow up in primary care, and a lay-led education programme adapted from Dr. Kate Lorig's Chronic Disease Self Management Programme. Evaluative data collection is underway.

For more information, contact Center Associate Dr. Chris Griffiths at c.j.griffiths@qmul.ac.uk