Abstract
AIM: To compare a nurse-led clinic in schools versus care in general practice for adolescents with asthma. DESIGN OF STUDY: Randomised controlled trial in four schools; parallel observational study in two schools. SETTING: Six comprehensive schools. METHOD: 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.
Full Text
The Full Text of this article is available as a PDF (84.8 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Chadwick S. The impact of asthma in an inner city general practice. Child Care Health Dev. 1996 May;22(3):175–186. [PubMed] [Google Scholar]
- Freudenberg N., Feldman C. H., Clark N. M., Millman E. J., Valle I., Wasilewski Y. The impact of bronchial asthma on school attendance and performance. J Sch Health. 1980 Nov;50(9):522–526. doi: 10.1111/j.1746-1561.1980.tb02079.x. [DOI] [PubMed] [Google Scholar]
- Gleeson C. Partnership in asthma care: the role of the school nurse. Health Visit. 1994 Jul;67(7):228–229. [PubMed] [Google Scholar]
- Hall D. M. School nursing: past, present, and future. Arch Dis Child. 1999 Aug;81(2):181–184. doi: 10.1136/adc.81.2.181. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jacobson L., Kinnersley P. Teenagers in primary care--continuing the new direction. Br J Gen Pract. 2000 Dec;50(461):947–948. [PMC free article] [PubMed] [Google Scholar]
- Jones K. P., Mullee M. A. Proactive, nurse-run asthma care in general practice reduces asthma morbidity: scientific fact or medical assumption? Br J Gen Pract. 1995 Sep;45(398):497–499. [PMC free article] [PubMed] [Google Scholar]
- Juniper E. F., Guyatt G. H., Feeny D. H., Ferrie P. J., Griffith L. E., Townsend M. Measuring quality of life in children with asthma. Qual Life Res. 1996 Feb;5(1):35–46. doi: 10.1007/BF00435967. [DOI] [PubMed] [Google Scholar]
- Juniper E. F., Guyatt G. H., Willan A., Griffith L. E. Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol. 1994 Jan;47(1):81–87. doi: 10.1016/0895-4356(94)90036-1. [DOI] [PubMed] [Google Scholar]
- Kaur B., Anderson H. R., Austin J., Burr M., Harkins L. S., Strachan D. P., Warner J. O. Prevalence of asthma symptoms, diagnosis, and treatment in 12-14 year old children across Great Britain (international study of asthma and allergies in childhood, ISAAC UK) BMJ. 1998 Jan 10;316(7125):118–124. doi: 10.1136/bmj.316.7125.118. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lewis E. Setting up a school asthma clinic. Prof Nurse. 1999 Sep;14(12):825–827. [PubMed] [Google Scholar]
- Lister-Sharp D., Chapman S., Stewart-Brown S., Sowden A. Health promoting schools and health promotion in schools: two systematic reviews. Health Technol Assess. 1999;3(22):1–207. [PubMed] [Google Scholar]
- Premaratne U. N., Sterne J. A., Marks G. B., Webb J. R., Azima H., Burney P. G. Clustered randomised trial of an intervention to improve the management of asthma: Greenwich asthma study. BMJ. 1999 May 8;318(7193):1251–1255. doi: 10.1136/bmj.318.7193.1251. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Price J. F. Issues in adolescent asthma: what are the needs? Thorax. 1996 Jan;51 (Suppl 1):S13–S17. doi: 10.1136/thx.51.suppl_1.s13. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shah S., Peat J. K., Mazurski E. J., Wang H., Sindhusake D., Bruce C., Henry R. L., Gibson P. G. Effect of peer led programme for asthma education in adolescents: cluster randomised controlled trial. BMJ. 2001 Mar 10;322(7286):583–585. doi: 10.1136/bmj.322.7286.583. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Steen N., Hutchinson A., McColl E., Eccles M. P., Hewison J., Meadows K. A., Blades S. M., Fowler P. Development of a symptom based outcome measure for asthma. BMJ. 1994 Oct 22;309(6961):1065–1068. doi: 10.1136/bmj.309.6961.1065. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Torgerson D. J. Contamination in trials: is cluster randomisation the answer? BMJ. 2001 Feb 10;322(7282):355–357. doi: 10.1136/bmj.322.7282.355. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ukoumunne O. C., Gulliford M. C., Chinn S., Sterne J. A., Burney P. G., Donner A. Methods in health service research. Evaluation of health interventions at area and organisation level. BMJ. 1999 Aug 7;319(7206):376–379. doi: 10.1136/bmj.319.7206.376. [DOI] [PMC free article] [PubMed] [Google Scholar]