RCT Abstract - At-Risk Registers Integrated into primary care to Stop Asthma crises in the UK

<bold>Background:</bold> Avoiding hospital admissions is a crucial aspect of asthma care. A regional trial suggested that the implementation of at-risk registers for asthma in primary care may improve hospital admission rates. <bold>Aim:</bold> To assess, via a national study, whether the ARRISA-UK programme reduced asthma crisis events. <bold>Methods:</bold> This was a cluster randomised trial of a complex intervention across 275 primary care practices throughout the UK. The intervention comprised identification of those at-risk, practice-based training regarding at-risk asthma, a clinical decision support system alerting practice staff to patients’ at-risk status to facilitate prompt and opportunistic care, and practice support. Control practices continued with standard care. Patients (n=10945) were included if they were identified as being at-risk unless they declined data sharing. Routine data, with linkage between primary and secondary care, captured the primary endpoint of asthma-related crisis events (hospitalisation, A&E attendances or death). <bold>Results:</bold> Data from 184 practices (6207 patients) were available for a complete case analysis. There was no significant effect on the asthma crisis events: intervention 185/2959 (6.3%) control 235/3248 (7.2%) odds ratio (OR) 0.87 (95% CI 0.69,1.09; p=0.220), nor for the components of this composite endpoint. When adjusting for any baseline asthma-related hospitalisation and A&E attendance the adjusted OR was 0.82 (0.66,1.03; p=0.088). <bold>Conclusion:</bold> The primary analysis did not show a beneficial effect of the ARRISA approach on the primary outcome. Further analysis is required to determine whether this intervention is cost effective and to identify subgroups that may benefit.