OEDIPUS: A cluster randomised trial of education for South Asians with asthma, and their primary and secondary care physicians, to reduce unscheduled care

Abstract

Rationale: South Asians with asthma experience much higher morbidity than Whites with asthma in the UK. They also experience worse follow up in primary care after hospitalization compared to the White population. Previous trials in mixed ethnicity populations in the US and Europe suggest that: a) an asthma specialist nurse intervention can reduce unscheduled asthma care; b) education for physicians can lead to improvements in their patients' asthma control; c) lay-led self-management programmes can improve asthma. We used adaptations of these interventions in an effort to reduce unscheduled care for South Asians with asthma living in London. Aims: To test a multifaceted educational intervention for South Asians with asthma and their primary and secondary care physicians aimed at reducing unscheduled care. Methods: Eighty-seven family practices from two adjacent inner London districts were recruited and randomized to education (45 practices) or usual care (42 practices). We recruited South Asian asthma patients from these practices attending two large nearby acute hospitals with unscheduled care. We adapted the Michigan PACE Asthma Programme to educate specialist nurses and physicians from intervention practices in better consulting skills for ethnic minority patients. Patients recruited to the study from intervention practices were seen in outpatient care by PACE-trained specialist nurses who provided education and self-management advice, referred them for follow-up by their PACE-trained practices, and invited them to participate in an asthma adaptation of an anglicized version of the Stanford Chronic Disease Self Management Programme. Patients from control practices were seen in outpatient care by specialist nurses providing usual care. Patients were followed up for one year. The primary outcome variable, time to first exacerbation with cough resulting in unscheduled primary and secondary care, and the secondary outcome variable, time to first family physician asthma review, were analyzed using Cox's proportional hazards regression. Results: Three-hundred and seventy-five patients participated: 183 from intervention, 192 from control practices. There was no evidence that the intervention increased time to first exacerbation with cough: median 179 days versus 199 days, adjusted hazard ratio (AHR)=1.03, 95%CI: 0.79-1.35. There was evidence that it reduced time to first asthma review: median 52 days versus 198 days in controls, AHR=1.75, 95%CI: 1.35-2.28. Conclusion: This multifaceted intervention failed to reduce unscheduled care for South Asians with asthma but did improve follow up in primary care. Further efforts are needed to reduce unscheduled care in South Asians with asthma.