S137 The At-Risk Registers in Severe Asthma (ARRISA) Study: a cluster-randomised controlled trial in primary care

ObjectivesTo evaluate the effectiveness of using electronic registers to identify and improve management of high-risk asthma patients in primary care.DesignCluster-randomised controlled trial with stratification by high/low deprivation scores and 1-year follow-up.Participants29 GP practices in Norfolk, UK with suitable software systems used electronic searches and clinical knowledge to identify 911 patients aged 5+ years at high risk from their asthma as defined by British asthma guidelines (severe asthma plus adverse psychosocial characteristics, including poor adherence).InterventionIntervention practices established registers of high-risk asthma patients and used an electronic alert to identify these patients at all practice encounters. This allowed reception staff to prioritise appointments and facilitate patient access to clinicians and clinical staff to review patients' asthma at all opportunities. Practice staff received a 1-h tailored training session on the use of alerts and actions to be taken from a GP (MN) and nurse (JW). Control practices continued with routine care.OutcomesA composite measure of moderate–severe exacerbations (primary outcome, see Abstract S137 Table 1 for definition), disaggregated exacerbation-related events, consultations and medications (secondary outcomes) were derived from anonymous clinical data extracted from practice-based patient records for the year before and after implementation of registers.Abstract S137 Table 1Events per person per yearIntervention (N=14 pracs, 457 patients)Control (N=15 pracs, 454 patients)Rate ratio (95% CI)p ValueMedian (IQR) rate of moderate–severe exacerbations (composite of below*)1 (2)0 (2)1.21 (0.95 to 1.55)0.13No. (%) of patients hospitalised for asthma*15 (3.3)29 (6.4)0.52 (0.28 to 0.98)0.04No. (%) of patients attending A&E for asthma*29 (6.4)37 (8.2)0.73 (0.41 to 1.30)0.28No. (%) of patients attending out-of-hours for asthma*26 (5.7)32 (7.1)0.84 (0.46 to 1.51)0.56No. (%) of patients prescribed courses of oral prednisolone for exacerbations*247 (54.1)213 (46.9)1.24 (0.99 to 1.54)0.06No. (%) of patients prescribed nebulised short-acting β-agonists36 (7.9)63 (13.9)0.56 (0.37 to 0.84)0.005Median (IQR) no. inhaled short-acting β-agonists prescribed6 (10)7 (12)1.03 (0.89 to 1.19)0.70Median (IQR) dose of inhaled corticosteroids prescribed (μg/day)658 (1036)658 (1036)1.14 (1.00 to 1.30)0.04Median (IQR) no. inhaled long-acting β-agonists prescribed8 (9)6 (9)1.24 (1.08 to 1.42)0.003Median (IQR)