A letter intervention to GP practices to promote prescription uptake in school-age children with asthma during summer holidays (TRAINS study): a pragmatic cluster randomised controlled trial

TL;DR

A study tested if sending a letter to UK GPs about asthma care for children during summer holidays would increase medication pickup, but found no significant effect.

Contribution

This study evaluates the effectiveness of a passive letter-based intervention to promote asthma medication uptake in children.

Findings

Sending a letter to GPs did not significantly increase preventer prescription collection in children with asthma.

No reduction in unscheduled care visits was observed following the letter intervention.

The study suggests passive interventions may be insufficient to change clinical practice.

Abstract

In school-aged children, asthma exacerbation rates peak following the return to school after the summer break. A cluster randomised controlled trial (PLEASANT) found that sending a reminder letter from a family doctor to parents of children with asthma during summer holiday led to a 30% increase in prescription collection in August and a decrease in unscheduled care visits after school return in the period September to December. This intervention also resulted in an estimated cost saving of £36.07 per patient per year. We aimed to assess whether informing general practitioner (GP) practices about the PLEASANT trial and its results could lead to its adoptation in routine practice. A pragmatic open label cluster randomised trial was conducted in England, involving GP practices contributing to the Clinical Practice Research Datalink (CPRD). All GP practices in CPRD were stratified by practice size (decile) and randomly allocated (1:1) to either the intervention or control group. In June 2021, the intervention group received a letter from CPRD via mail and email, informing them about the PLEASANT study findings and offering recommendations. The primary outcome was the proportion of children with asthma (aged 4–15) who collected a preventer prescription in August and September 2021. The trial received both University of Sheffield and Independent Scientific Advisory Committee (ISAC) Ethics approval and was registered with ClinicalTrials.gov (NCT05226091). This study included 1389 GP practices and total of 105,746 children with asthma. The practices were randomly assigned to either the intervention group (n = 693 practices, 52,166 individuals) or the control group (n = 695 practices, 53,580 individuals). Analysis showed that 15,716 children (35.3%) in the intervention group and 16,001 children (35.1%) in the control group collected a preventer prescription. No statistically significant difference was found between the two groups (OR 1.01, 95% CI 0.97–1.04), suggesting the intervention had no effect on prescription collection. The study results indicate that a passive intervention, consisting of providing a letter to GPs, did not yield the desired results. To effectively bridge the gap between evidence and practice, it may be worthwhile to consider exploring more proactive strategies to address the identified issues. The trial was registered under ClinicalTrials.gov ID: NCT05226091.

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