MISSION is a new and novel way of delivering highly specialised asthma care and has the potential to change the way asthma care across the United Kingdom (UK) is delivered as well as services for other long term health conditions. The MISSION model is the first model of this type and the current research study aims to evaluate its success and to compare the MISSION service to current care delivery. This will be done in several different ways. The study is a mixed methods evaluation of the new service comparing outcomes before and after the intervention using retrospective data analysis and prospective qualitative interview. A control arm of patients not exposed to, but eligible for, the new intervention will also be included. The study will be conducted at Portsmouth Hospitals National Health Service (NHS) Trust and will recruit patients who attended MISSION clinics, outpatient asthma clinics, staff who attended MISSION clinics in a professional capacity and patients from GP surgeries where MISSION clinics were held who did not attend.
Purpose and design The purpose of the study is to evaluate in detail the clinical and health economic outcomes from the MISSION project. The MISSION clinics combined a new way of delivering asthma care along with actively case finding patients who were not already known to specialist services but who had uncontrolled or at risk asthma. The aim of the study is to compare the MISSION clinic model outcomes to current clinic model outcomes as well as performing qualitative interviews with patients who attended and staff who took part in the project.The research study was developed by a team from Portsmouth Hospital Trust and the University of Portsmouth including a research fellow, consultant and Professor, research methodologist, qualitative senior lecturer and independent statistician. A patient adviser also reviewed the lay summary and patient information sheets. The study undergoes independent review by another clinician as part of the sponsor process. The study is also part of an MD project for the University of Portsmouth. Design: This is a mixed methods study. A quantitative analysis of data from patients who attended the MISSION Rapid Access Asthma Clinics (RAAC), patients who attended the MISSION Severe Asthma Assessment Clinics (SAAC), patients who were invited to the RAAC but did not attend and patients who have been referred by their GP to the severe asthma clinic during the same time MISSION was running. The data analysis will include asthma control, hospital admissions, GP appointments, related medical conditions,medications, investigations and assessments done and time between appointments. A qualitative study will be conducted using telephone interviews with patients who attended the SAAC and health care professionals who took part in the MISSION clinics. The aim is to recruit: * 44 MISSION patients (of whom 20 attended both the RAAC and the SAAC), * 132 patients who were invited to MISSION RAAC but did not attend * 20 patients referred to the severe asthma clinic at the hospital * 20 health care professionals who took part in the MISSION clinics Methodology: Participants will be approached for consent by post. They will be given time to read the information and return the consent form to the study team. They will be given a contact number to discuss any questions. Once a participant has consented to the quantitative study there is no further study procedures for the participant. Participants will be asked for consent to collect data from their GP and hospital records for the study. This will be entered onto a form (CRF) against a study number and then into a password protected study database held on a secure server at Portsmouth Hospitals NHS Trust. This data will then be analysed by a statistician and research fellow. Participants for qualitative interview will have an interview over the telephone lasting 45 minutes to one hour. This will be recorded and transcribed. The participant will be given the transcript to read and correct. The transcripts will then be analysed looking for themes.
Study Type
OBSERVATIONAL
Enrollment
92
Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital
Portsmouth, Hampshire, United Kingdom
Asthma control as measured by exacerbation frequency for all patients
The primary endpoint is asthma control as measured by exacerbation frequency (defined as deterioration in symptoms requiring ≥30mg prednisolone or equivalent for ≥3 days) for all patients
Time frame: 6 months
Short acting bronchodilator (SABA) use
Short acting bronchodilator (SABA) use measured by number of inhalers prescribed in 6 months pre and post MISSION SAAC, RAAC or outpatient clinic.
Time frame: 6 months
Exacerbation frequency
Exacerbation frequency (defined as deterioration in symptoms requiring ≥30mg prednisolone or equivalent for ≥3 days) in 6 months pre and post MISSION SAAC, RAAC or outpatient clinic.
Time frame: 6 months
Health care usage costs for asthma and number of contacts
Health care usage costs for asthma and number of contacts (GP visits, Emergency Department (ED) or out of hour attendances (OOH), hospital admissions, emergency GP visits) over 6 months pre and post MISSION or outpatient clinic.
Time frame: 6 months
Assessment of co-morbidity
Assessment of comorbidity (rhinosinusitis, anxiety and depression, dysfunctional breathing, gastro oesophageal reflux and obstructive sleep apnoea) and method of assessment for MISSION SAAC patients and outpatient severe asthma clinic patients
Time frame: 6 months
Assessment of inhaler technique and recommendations for inhaler devices.
Assessment of inhaler technique and recommendations for inhaler devices for MISSION SAAC patients and outpatient severe asthma clinic patients
Time frame: 6 months
Smoking cessation advice.
Smoking cessation advice for MISSION SAAC patients and outpatient severe asthma clinic patients
Time frame: 6 months
Investigations performed in secondary care
Investigations performed during 6 months in secondary care e.g. full lung function, sputum induction, High-Resolution Computed Tomography (HRCT) chest for MISSION SAAC patients and outpatient severe asthma clinic patients
Time frame: 6 months
Time from GP referral to 1st clinic visit
Time from GP referral to 1st clinic visit in secondary care for MISSION SAAC patients and outpatient severe asthma clinic patients
Time frame: 6 months
Time between 1st and 2nd visit
Time between 1st and 2nd visit in secondary care for MISSION SAAC patients and outpatient severe asthma clinic patients
Time frame: 6 months
Time to appointment with other specialists
Time to appoint with other specialists for asthma related comorbidity where indicated, e.g. dietician, Ear, Nose \& Throat (ENT), physiotherapists, psychologist, CT imaging for MISSION SAAC patients and outpatient severe asthma clinic patients
Time frame: 6 months
Fractional Exhaled Nitric Oxide (FeNO) Assessment
Assessment of eosinophilic airways inflammation by FeNO for MISSION SAAC patients and outpatient severe asthma clinic patients
Time frame: 6 months
Frequency of non-attendance
The frequency of non-attendance at clinic for MISSION SAAC patients and outpatient severe asthma clinic patients
Time frame: 6 months
Severity of co-morbidities
Severity of co-morbidities for MISSION RAAC patients
Time frame: 6 months
Frequency of co-morbidities
Frequency of co-morbidities for MISSION RAAC patients
Time frame: 6 months
Frequency & type of allergy
Frequency \& type of allergy for MISSION RAAC patients
Time frame: 6 months
Measurement of exhaled nitric oxide
Measurement of exhaled nitric oxide for MISSION RAAC patients
Time frame: 6 months
Measurement & variation of lung function (Single
Composite measurement \& variation of lung function for MISSION RAAC patients
Time frame: 6 months
Frequency and type of additional asthma control medication.
Frequency and type of additional asthma control medication for MISSION RAAC patients
Time frame: 6 months
Quality of life
Quality of life as assessed by the Asthma Quality of Life Questionnaire (AQLQ).
Time frame: 6 months
Disease control
Disease control as assessed by the Asthma Control Questionnaire (ACQ)
Time frame: 6 months
Number of Forced Expiratory Volume at one second (FEV1) / Forced Vital Capacity (FVC) measurements
Number of patients having measurements of FEV1/FVC as a proxy for asthma control and severity in the MISSION RAAC patient and primary care patients
Time frame: 6 months
Prescription of SABA's
Prescription of Short Acting Bronchodilators (SABAs) during last 6 months at baseline and 6 months for MISSION RAAC and primary care patients.
Time frame: 6 months previous
Prescription of SABA's
Prescription of Short Acting Bronchodilators (SABAs) during last 6 months at baseline and 6 months for MISSION RAAC and primary care patients.
Time frame: Baseline
Prescription of SABA's
Prescription of Short Acting Bronchodilators (SABAs) during last 6 months at baseline and 6 months for MISSION RAAC and primary care patients.
Time frame: 6 months
Exacerbation rates
Exacerbation rates (defined as deterioration in symptoms requiring ≥30mg prednisolone or equivalent for ≥3 days) during the last 6 months at baseline and 6 months for MISSION RAAC and primary care patients.
Time frame: 6 months previous
Exacerbation rates
Exacerbation rates (defined as deterioration in symptoms requiring ≥30mg prednisolone or equivalent for ≥3 days) during the last 6 months at baseline and 6 months for MISSION RAAC and primary care patients.
Time frame: Baseline
Exacerbation rates
Exacerbation rates (defined as deterioration in symptoms requiring ≥30mg prednisolone or equivalent for ≥3 days) during the last 6 months at baseline and 6 months for MISSION RAAC and primary care patients.
Time frame: 6 months
ED attendances during the last 6 months
Emergency Department (ED) attendances during the last 6 months at baseline and 6 months for MISSION RAAC and primary care patients.
Time frame: 6 months previous
Out Of Hours (OOH) contacts during the last 6 months
Out Of Hours (OOH) contacts during the last 6 months at baseline and 6 months for MISSION RAAC and primary care patients.
Time frame: 6 months previous
Hospital admissions during the last 6 months
Emergency Department (ED) attendances, Out Of Hours (OOH) contacts and hospital admissions during the last 6 months at baseline and 6 months for MISSION RAAC and primary care patients.
Time frame: 6 months previous
ED attendances at baseline
Emergency Department (ED) attendances at baseline for MISSION RAAC and primary care patients.
Time frame: Baseline
OOH contacts at baseline
Out Of Hours (OOH) contacts at baseline for MISSION RAAC and primary care patients.
Time frame: Baseline
Hospital admissions at baseline
Hospital admissions at baseline for MISSION RAAC and primary care patients.
Time frame: Baseline
ED attendances at 6 months.
Emergency Department (ED) attendances at 6 months for MISSION RAAC and primary care patients.
Time frame: 6 months
Out Of Hours (OOH) contacts at 6 months
Out Of Hours (OOH) contacts at 6 months for MISSION RAAC and primary care patients.
Time frame: 6 months
Hospital admissions during at 6 months
Hospital admissions during at 6 months for MISSION RAAC and primary care patients.
Time frame: 6 months
Inhaled steroid doses and usage
Inhaled steroid doses and usage for MISSION RAAC and primary care patients.
Time frame: 6 months
sensitivity and specificity of the Primary Care Information Services (PRIMIS) Asthma Audit Tool
The sensitivity and specificity of the PRIMIS Asthma Audit Tool in identifying the patients compared to gold standard specialist assessment and interrogation of primary care records for MISSION RAAC and primary care patients.
Time frame: 6 months
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