Clustered randomised trial of an intervention to improve the management of asthma: Greenwich asthma study

Premaratne, U. N.; Sterne, Jonathan A C; Marks, Guy B.; Webb, Justin; Azima, Hossain; Burney, Peter

doi:10.1136/bmj.318.7193.1251

Cited by 83 publications

(36 citation statements)

References 20 publications

(19 reference statements)

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“…Although there are reports of significant improvements in patient outcomes following the implementation of practice guidelines (11,18), failure of the guidelines to produce a measurable impact on patient outcomes has also been documented (6,10,(19)(20)(21). In the present study, we have documented some better than average levels of inhaled corticosteroid use and a low level of reliance on inhaled beta 2 -agonists (7,9).…”

Section: Discussionsupporting

confidence: 49%

The Impact of Asthma Management Guideline Dissemination on the Control of Asthma in the Community

Cowie

Underwood

Mack³

2001

Canadian Respiratory Journal

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OBJECTIVE: To measure the impact of asthma management education on the control of asthma in the community.DESIGN: A cross-sectional study comparing three communities.SETTING: Three rural communities in southern Alberta.PATIENTS AND METHODS: A population sample of patients with asthma attending a pharmacy to fill a prescription for asthma medication were selected from three communities. Patients were asked to complete a questionnaire relating to their asthma management and control.INTERVENTION: Three levels of asthma management education were provided in the three communities with populations of 6000 to 10,000. The levels of education ranged from standard continuing medical education programs relating to the national asthma guidelines and a visiting asthma nurse educator to the establishment of an asthma clinic and a multiple-target, intensive education program for health professionals, town leaders, local media, schools and the public. The survey of the population with asthma was conducted approximately one year after the education program had been completed.RESULTS: A total of 327 completed questionnaires were submitted. Analysis showed that there was no significant difference that could be attributed to the intervention in the management of asthma or in the level of asthma control among the patients from the three communities.RESULTS: A total of 327 completed questionnaires were submitted. Analysis showed that there was no significant difference that could be attributed to the intervention in the management of asthma or in the level of asthma control among the patients from the three communities.

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Section: Discussionsupporting

confidence: 49%

The Impact of Asthma Management Guideline Dissemination on the Control of Asthma in the Community

Cowie

Underwood

Mack³

2001

Canadian Respiratory Journal

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“…Epilepsy has not been prioritized by health care providers either at a national or a local level. The failure of the interventions to affect professional behavior should be viewed in the context of a number of recent trials looking at implementation strategies, including computerized decison-making tools, for guidelines in the fields of asthma, coronary heart disease, and leg ulcers have also failed to show changes in practice (21,23,24,28). All of these conditions have a much higher prevalence, are given higher priority, and are commonly treated in primary care.…”

Section: Conclusion: Implications For Epilepsy Carementioning

confidence: 99%

Implementation Strategies for a Scottish National Epilepsy Guideline in Primary Care: Results of the Tayside Implementation of Guidelines in Epilepsy Randomized (TIGER) Trial

et al. 2003

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Summary: Purpose: To determine the effectiveness of two dissemination and implementation strategies to implement a national guideline for epilepsy management in primary care settings. Methods: Three‐arm cluster‐randomized controlled trial. The participants were general practitioners from 68 practices in Tayside, Scotland, and 1,133 of their patients with self‐reported epilepsy treated with antiepileptic medications (AEDs). Practices were randomized blind to a control, intermediate, or intensive intervention. Control: Postal dissemination of a nationally developed clinical guideline. Intermediate intervention: Postal dissemination of the guideline supported by interactive, accredited workshops, and dedicated, structured protocol documents. Intensive intervention: Intermediate intervention plus a nurse specialist who supported and educated practices in the establishment of epilepsy review clinics. The primary outcome was the SF‐36 health‐related quality‐of‐life instrument. Secondary measures were a battery of prevalidated epilepsy‐specific quality‐of‐life instruments. These were administered at baseline and after the intervention phase. Process of care was assessed by case‐note review on number of review meetings and counseling sessions for epilepsy before and after the interventions. Results: None of the intervention groups showed any change in the primary or secondary outcome measures or process‐of‐care measures. Conclusions: None of the intervention strategies led to improvements in patient quality of life or quality of epilepsy care. Further research is needed to discover why the interventions failed, to identify barriers to adoption of guidelines, and to develop strategies that might improve implementation and uptake in the future.

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“…Instead of individuals being randomized to different interventions, whole family practices, geographical areas or other distinct units are randomly allocated. This may be because the intervention is at the cluster level [12], to avoid "contamination" between individuals [13] or to estimate the total community benefit [14]. A draft extension [15] of the CONSORT (Consolidated Standards of Reporting Trials) statement [1] for individually randomized trials has been published.…”

Section: Other Types Of Studymentioning

confidence: 99%

Statistics for theEuropean Respiratory Journal

Chinn¹

2001

Eur Respir J

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This review summarizes statistical methods likely to be needed by researchers. It is not a replacement for a statistics book, and almost no symbols or mathematics are used. It seeks to guide researchers to the appropriate methods and to make them aware of some common pitfalls.Sections deal with methods for quantitative outcomes, both basic and more advanced, and parallel methods for qualitative or categorical outcomes. Reference is made to papers using the more advanced methods in theEuropean Respiratory Journalin order that their relevance may be appreciated.The paper seeks to improve the quality of papers submitted to theEuropean Respiratory Journal, to reduce the revisions to papers required of authors, and to enable readers of the journal to gain more insight into the interpretation of results.

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Clustered randomised trial of an intervention to improve the management of asthma: Greenwich asthma study

Abstract: This model of service delivery is not effective in improving the outcome of asthma in the community. Further development is required if cost effective management of asthma is to be introduced.

Cited by 83 publications

References 20 publications

The Impact of Asthma Management Guideline Dissemination on the Control of Asthma in the Community

The Impact of Asthma Management Guideline Dissemination on the Control of Asthma in the Community

Implementation Strategies for a Scottish National Epilepsy Guideline in Primary Care: Results of the Tayside Implementation of Guidelines in Epilepsy Randomized (TIGER) Trial

Statistics for theEuropean Respiratory Journal

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