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

Objectives To evaluate the effectiveness of an asthma resource centre in im proving treatment and quality of life for asthmatic patients. Design Community based randomised controlled trial. Setting 41 general practices in Greenwich with a practice nurse. Subjects All registered patients aged 15-50 years. Intervention Nurse speci alists in asthma who educated and supported practice nurses,who in turn edu cated patients in the management of asthma according to the British Thoraci c Society's guidelines. Main outcome measures Quality of life of asthmatic patients, attendance at accident and emergency departments, admissions to local hospitals, and ster oid prescribing by general practitioners. Results Of 24 400 patients randomly selected and surveyed in 1993, 12 238 r eplied; 1621 were asthmatic of whom 1291 were sent a repeat questionnaire i n 1996 and 780 replied. Of 24 400 patients newly surveyed in 1996, 10 783 ( 1616 asthmatic) replied. No evidence was found for an improvement in asthma related quality of life among newly surveyed patients in intervention prac tices compared with control practices, Neither was there evidence of an imp rovement in other measures of the quality of asthma care. Weak evidence was found for an improvement in quality of life in intervention practices amon g asthmatics registered with study practices in 1993 and followed up in 199 6. Neither attendances at accident and emergency departments nor admissions for asthma showed any tendency to diverge in intervention and control prac tices over the study period. Steroid prescribing rates rose steadily during the study period. The average annual increase in steroid prescribing was 3 % per year higher in intervention than control practices (95% confidence in terval - 1% to 6%, P = 0.10). Conclusions This model of service delivery is not effective in improving th e outcome of asthma in the community. Further development is required if co st effective management of asthma is to be introduced.