National roll-out of latent tuberculosis testing and treatment for new migrants in England: a retrospective evaluation in a high-incidence area

M. Burman was funded by Bart's Charity and D. Zenner is affiliated with the National Institute for Health Research Health Protection Research Unit (NIHRHPRU) in Respiratory Infections at Imperial College London in partnership with Public Health England (PHE). The research received funding from the NIHR HPRU in Respiratory Infections at Imperial College London in Partnership with PHE

Effect of an Education Programme for South Asians with Asthma and Their Clinicians: A Cluster Randomised Controlled Trial (OEDIPUS).

BACKGROUND: People with asthma from ethnic minority groups experience significant morbidity. Culturally-specific interventions to reduce asthma morbidity are rare. We tested the hypothesis that a culturally-specific education programme, adapted from promising theory-based interventions developed in the USA, would reduce unscheduled care for South Asians with asthma in the UK. METHODS: A cluster randomised controlled trial, set in two east London boroughs. 105 of 107 eligible general practices were randomised to usual care or the education programme. Participants were south Asians with asthma aged 3 years and older with recent unscheduled care. The programme had two components: the Physician Asthma Care Education (PACE) programme and the Chronic Disease Self Management Programme (CDSMP), targeted at clinicians and patients with asthma respectively. Both were culturally adapted for south Asians with asthma. Specialist nurses, and primary care teams from intervention practices were trained using the PACE programme. South Asian participants attended an outpatient appointment; those registered with intervention practices received self-management training from PACE-trained specialist nurses, a follow-up appointment with PACE-trained primary care practices, and an invitation to attend the CDSMP. Patients from control practices received usual care. Primary outcome was unscheduled care. FINDINGS: 375 south Asians with asthma from 84 general practices took part, 183 registered with intervention practices and 192 with control practices. Primary outcome data were available for 358/375 (95.5%) of participants. The intervention had no effect on time to first unscheduled attendance for asthma (Adjusted Hazard Ratio AHR = 1.19 95% CI 0.92 to 1.53). Time to first review in primary care was reduced (AHR = 2.22, (1.67 to 2.95). Asthma-related quality of life and self-efficacy were improved at 3 months (adjusted mean difference -2.56, (-3.89 to -1.24); 0.44, (0.05 to 0.82) respectively. CONCLUSIONS: A multi-component education programme adapted for south Asians with asthma did not reduce unscheduled care but did improve follow-up in primary care, self-efficacy and quality of life. More effective interventions are needed for south Asians with asthma

Kaplan-Meier estimate of probability of attending for first episode of unscheduled asthma care by days since intervention

<p>Kaplan-Meier estimate of probability of attending for first episode of unscheduled asthma care by days since intervention</p

Adaptation of educational programmes

<p>Adaptation of educational programmes</p

Flow of practices and patients through the study

<p>Flow of practices and patients through the study</p

Primary outcomes Median time to first unscheduled care: 171 days (Intervention), 189 days (control)

<p>Primary outcomes Median time to first unscheduled care: 171 days (Intervention), 189 days (control)</p

Patient characteristics

<p>Patient characteristics</p

Practice characteristics used in the minimisation, stratified by Borough

<p>Practice characteristics used in the minimisation, stratified by Borough</p

Secondary outcomes from interviews held at 3 months after intervention

<p>Secondary outcomes from interviews held at 3 months after intervention</p

Secondary outcomes from medical records.

<p>Median time to review 72 days (Intervention), 339 days (control)</p