The PLEASANT study

Preventing and Lessening Exacerbations of Asthma in School-age children Associated with a New Term

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Context

After the return to school each year in September there is an increase in medical contacts for children with asthma. It is believed this is because of the viral challenge children face after returning to school when they begin to mix with children in school after the summer vacation.

Children without asthma also have an increase in medical contacts; however, children with asthma are twice as likely to see their doctor after the school return.

Preceding the return to school there is a marked drop in the number of prescriptions that are collected and children not collecting their prescriptions are more likely to see their doctor.

Intervention which increased prescription update and adherence are important in the management of asthma in school age children.


What we did and what we found

We undertook a cluster of randomised trials with 1,279 school-age children in 142 general practices (70 randomised to intervention)

We found that a letter sent from the family doctor to a parent with a child with asthma informing them of the importance of taking asthma medication prior to the start of the school year increased prescriptions by 30% and reduced medical contacts in the periods September to December and September to August.

This reduction in medical contacts means the intervention is estimated as cost saving, with a saving of £36.07 per patient.


The impact

If implemented the intervention could increase prescription uptake, reduce medical contacts and be cost saving.

We found that half the practices in the intervention arm repeated the intervention the following year even though the study had ended.


Future plans

The plan is to take this work forward to disseminate the results of PLEASANT to get the intervention implemented.

The IMP2ART program grant has just started to complement this research by evaluating personalised action plans.


    Downloads

    PLEASANT protocol paper (PDF, 1.2MB)

    GP expression of interest form (PDF, 319KB)

    GP information sheet (PDF, 474KB)

    Read codes for data extraction (DOC, 159KB)

    Article: Recruiting Primary Care Research Sites - the PLEASANT experience (PDF, 564KB)

    Report: Assessment of the resources used by General Practices in sending out the intervention (PDF, 275KB)

    Data management procedure (DOC, 97KB)

    Intervention letter (DOC, 16KB)


    Publications

    • Julious SA, Horspool MJ, Davis S, Franklin M, Smithson WH, Norman P, Simpson RM, Elphick H, Bortolami O & Cooper C (2018) Open-label, cluster randomised controlled trial and economic evaluation of a brief letter from a GP on unscheduled medical contacts associated with the start of the school year: the PLEASANT trial. BMJ Open, 8(4), e017367.
    • Franklin M, Davis S, Horspool M, Kua WS & Julious S (2017) Economic Evaluations Alongside Efficient Study Designs Using Large Observational Datasets: the PLEASANT Trial Case Study. PharmacoEconomics, 35(5), 561-573.
    • Julious SA, Horspool MJ, Davis S, Bradburn M, Norman P, Shephard N, Cooper CL, Smithson WH, Boote J, Elphick H , Loban A et al (2017) PLEASANT: Preventing and Lessening Exacerbations of Asthma in School-age children Associated with a New Term - a cluster randomised controlled trial and economic evaluation.. Health Technology Assessment, 20(93), 1-154.
    • Boote J, Julious SA, Horspool MJ, Smithson WH, Elphick H, Norman P. PPI in the PLEASANT trial: Involving children with asthma and their parents in the design of a randomised controlled trial. Primary Health Care Research & Development 2016 DOI:10.1017/S1463423616000025
    • Horspool MJ, Julious SA, Mooney C, May R, Sully B & Smithson WH (2015) Preventing and Lessening Exacerbations of Asthma in School-aged children Associated with a New Term (PLEASANT): Recruiting Primary Care Research Sites–the PLEASANT experience. Primary Care Respiratory Journal, 25(1), 15066.
    • Horspool MJ, Julious SA, Boote J, Bradburn MJ, Cooper CL, Davis S, Elphick H, Norman P, Smithson WH & vanStaa T (2013) Preventing and lessening exacerbations of asthma in school-age children associated with a new term (PLEASANT): Study protocol for a cluster randomised control trial. Trials, 14(1).

    PLEASANT team

    Name and role Location Email Phone
    Dr Steven A Julious, Chief Investigator Medical Statistics Group, ScHARR, University of Sheffield s.a.julious@sheffield.ac.uk +44(0)1442220709
    Dr Michelle Horspool, Trial Manager Clinical Trials Research Unit, ScHARR, University of Sheffield m.horspool@sheffield.ac.uk +44(0)1442224303
    Dr Cindy Cooper, CTRU Director Clinical Trials Research Unit, ScHARR, University of Sheffield c.l.cooper@sheffield.ac.uk +44(0)1442220743
    Dr Henry Smithson, General Practitioner Academic Unit of Primary Medical Care, University of Sheffield henry.smithson@ucc.ie  
    Dr Jonathan Boote, Lead for Patient & Public Involvement ScHARR, University of Sheffield j.boote@sheffield.ac.uk +44(0)1442220892
    Gerry McCann, Business Development & Clinical Trials Manager Clinical Practice Research Datalink, MHRA, London gerard.mccann@mhra.gsi.gov.uk +44(0)2030806019
    Ms Sarah Davis, Health Economist Health Economics and Decision Sciences, ScHARR, University of Sheffield s.davis@sheffield.ac.uk +44(0)1442225209
    Dr Paul Norman, Health Psychologist Department of Psychology, University of Sheffield p.norman@sheffield.ac.uk +44(0)1442226505
    Dr Heather Elphick, Consultant in Paediatric Respiratory Medicine Paediatric Respiratory Medicine, Sheffield Children's Hospital heather.elphick@sch.nhs.uk +44(0)1442220733
    Ms Helen Wakefield, Trials Support Officer Clinical Trials Research Unit, ScHARR, University of Sheffield h.wakefield@sheffield.ac.uk  
    Mr Mike Bradburn, Medical Statistician Clinical Trials Research Unit, ScHARR, University of Sheffield m.bradburn@sheffield.ac.uk +44(0)1442220706
    Mr Neil Shephard, Medical Statistician Clinical Trials Research Unit, ScHARR, University of Sheffield    
    Dr Amanda Loban, Data Manager Clinical Trials Research Unit, ScHARR, University of Sheffield a.loban@sheffield.ac.uk +44(0)1442222995
    Miss Cara Mooney, Research Assistant Clinical Trials Research Unit, ScHARR, University of Sheffield c.d.mooney@sheffield.ac.uk +44(0)1442224308
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