A randomised controlled trial of clinics in secondary schools for adolescents with asthma.
OBJECTIVE
To compare a nurse-led clinic in schools versus care in general practice for adolescents with asthma.


METHODS
Randomised controlled trial in four schools; parallel observational study in two schools.


METHODS
Six comprehensive schools.


METHODS
In the randomised trial, pupils were invited to attend asthma review at a nurse-led clinic either in school, or in general practice. The parallel observational study compared pupils invited to practice care within and outside the randomised trial. Primary outcome measures were attendance for asthma review, symptom control, and quality of life. Secondary outcomes were knowledge, attitudes, inhaler technique, use of steroids, school absence, peak flow rate, preference for future care, health service utilisation, and costs.


RESULTS
School clinic pupils were more likely to attend an asthma review than those randomised to practice care (90.8% versus 51.0% overall [P < 0.001, not consistent across schools]). No differences were observed in symptom control (P = 0.42) or quality of life (P = 0.63). Pupils attending school clinics had greater knowledge of asthma (difference = +0.38, 95% CI = 0.19 to 0.56), more positive attitudes (difference = +0.21, 95% CI = 0.05 to 0.36), and better inhaler technique (P < 0.001, not consistent across all schools). No differences were observed in school absence or peak flow rate. A majority (63%) of those who had received care at school preferred this model in future. Median costs of providing care at school and at the practice were 32.10 Pounds and 19.80 Pounds, respectively. No differences were observed between the groups in the observational comparison on any outcome.


CONCLUSIONS
The schools asthma clinic increased uptake of asthma reviews. There were improvements in various process measures, but not in clinical outcomes.
Salisbury
Chris
C
Division of Primary Health Care, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL. c.salisbury@bristol.ac.uk
Francis
Caia
C
Rogers
Chris
C
Parry
Kate
K
Thomas
Huw
H
Chadwick
Stephanie
S
Turton
Pat
P
D000041:Absenteeism; D000280:Administration, Inhalation; D000293:Adolescent; D000465:Algorithms; D001249:Asthma / Q000188:drug therapy / Q000451:nursing*; D001294:Attitude to Health; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012572:School Health Services / Q000458:organization & administration*