Specialist nurse intervention to reduce unscheduled asthma care in a deprived multiethnic area: the east London randomised controlled trial for high risk asthma (ELECTRA).
OBJECTIVE
To determine whether asthma specialist nurses, using a liaison model of care, reduce unscheduled care in a deprived multiethnic area.


METHODS
Cluster randomised controlled trial.


METHODS
44 general practices in two boroughs in east London.


METHODS
324 people aged 4-60 years admitted to or attending hospital or the general practitioner out of hours service with acute asthma; 164 (50%) were South Asian patients, 108 (34%) were white patients, and 52 (16%) were from other, largely African and Afro-Caribbean, ethnicities.


METHODS
Patient review in a nurse led clinic and liaison with general practitioners and practice nurses comprising educational outreach, promotion of guidelines for high risk asthma, and ongoing clinical support. Control practices received a visit promoting standard asthma guidelines; control patients were checked for inhaler technique.


METHODS
Percentage of participants receiving unscheduled care for acute asthma over one year and time to first unscheduled attendance.


RESULTS
Primary outcome data were available for 319 of 324 (98%) participants. Intervention delayed time to first attendance with acute asthma (hazard ratio 0.73, 95% confidence interval 0.54 to 1.00; median 194 days for intervention and 126 days for control) and reduced the percentage of participants attending with acute asthma (58% (101/174) v 68% (99/145); odds ratio 0.62, 0.38 to 1.01). In analyses of prespecified subgroups the difference in effect on ethnic groups was not significant, but results were consistent with greater benefit for white patients than for South Asian patients or those from other ethnic groups.


CONCLUSIONS
Asthma specialist nurses using a liaison model of care reduced unscheduled care for asthma in a deprived multiethnic health district. Ethnic groups may not benefit equally from specialist nurse intervention.
Griffiths
Chris
C
Centre for General Practice and Primary Care, Institute of Community Health Sciences, Barts and the London, Medical Sciences, Queen Mary's School of Medicine and Dentistry, Queen Mary, University of London E1 4NS. c.j.griffiths@qmul.ac.uk
Foster
Gill
G
Barnes
Neil
N
Eldridge
Sandra
S
Tate
Helen
H
Begum
Shamoly
S
Wiggins
Mo
M
Dawson
Carolyn
C
Livingstone
Anna Eleri
AE
Chambers
Mike
M
Coats
Tim
T
Harris
Roger
R
Feder
Gene S
GS
D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000208:ethnology / Q000451:nursing*; D016000:Cluster Analysis; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011204:Poverty Areas; D011379:Prognosis; D011788:Quality of Life; D012648:Self Care