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

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dc.contributor.author Julious, Steven A.
dc.contributor.author Horspool, Michelle J.
dc.contributor.author Davis, Sarah
dc.contributor.author Franklin, Matthew
dc.contributor.author Smithson, W. Henry
dc.contributor.author Norman, Paul
dc.contributor.author Simpson, Rebecca M.
dc.contributor.author Elphick, Heather
dc.contributor.author Bortolami, Oscar
dc.contributor.author Cooper, Cindy
dc.date.accessioned 2019-07-16T16:01:39Z
dc.date.available 2019-07-16T16:01:39Z
dc.date.issued 2018-04-20
dc.identifier.citation Julious, S.A., Horspool, M.J., Davis, S., Franklin, M., Smithson, W.H., Norman, P., Simpson, R.M., Elphick, H., Bortolami, O. and 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. DOI: 10.1136/bmjopen-2017-017367 en
dc.identifier.volume 8 en
dc.identifier.issued 4 en
dc.identifier.startpage 1 en
dc.identifier.endpage 11 en
dc.identifier.uri http://hdl.handle.net/10468/8178
dc.identifier.doi 10.1136/bmjopen-2017-017367 en
dc.description.abstract Background Asthma is seasonal with peaks in exacerbation rates in school-age children associated with the return to school following the summer vacation. A drop in prescription collection in August is associated with an increase in the number of unscheduled contacts after the school return.Objective To assess whether a public health intervention delivered in general practice reduced unscheduled medical contacts in children with asthma.Design Cluster randomised trial with trial-based economic evaluation. Randomisation was at general practice level, stratified by size of practice. The intervention group received a letter from their general practitioner (GP) in late July outlining the importance of (re)taking asthma medication before the return to school. The control group was usual care.Setting General practices in England and Wales.Participants 12 179 school-age children in 142 general practices (70 randomised to intervention).Main outcome Proportion of children aged 5–16 years who had an unscheduled contact in September. Secondary endpoints included collection of prescriptions in August and medical contacts over 12 months (September–August). Economic endpoints were quality-adjusted life-years gained and health service costs.Results There was no evidence of effect (OR 1.09; 95% CI 0.96 to 1.25 against treatment) on unscheduled contacts in September. The intervention increased the proportion of children collecting a prescription in August by 4% (OR 1.43; 95% CI 1.24 to 1.64). The intervention also reduced the total number of medical contacts between September–August by 5% (incidence ratio 0.95; 95% CI 0.91 to 0.99).The mean reduction in medical contacts informed the health economics analyses. The intervention was estimated to save £36.07 per patient, with a high probability (96.3%) of being cost-saving.Conclusions The intervention succeeded in increasing children collecting prescriptions. It did not reduce unscheduled care in September (the primary outcome), but in the year following the intervention, it reduced the total number of medical contacts.Trial registration number ISRCTN03000938. en
dc.description.sponsorship Health Technology Assessment Programme (Grant 11/01/10) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher BMJ Publishing Group en
dc.relation.uri https://bmjopen.bmj.com/content/8/4/e017367
dc.rights © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ en
dc.rights.uri https://creativecommons.org/licenses/by/4.0/ en
dc.subject Asmtha en
dc.subject Public health intervention en
dc.subject General practice en
dc.subject Scool-age children en
dc.title 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 en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Henry Smithson, Department of General Practice, University College Cork, Cork, Ireland. +353-21-490-3000 Email: henry.smithson@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder Health Technology Assessment Programme en
dc.contributor.funder Sheffield Clinical Commissioning Group en
dc.description.status Peer reviewed en
dc.identifier.journaltitle BMJ Open en
dc.internal.IRISemailaddress henry.smithson@ucc.ie en
dc.identifier.articleid e017367 en
dc.identifier.eissn 2044-6055


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© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ Except where otherwise noted, this item's license is described as © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
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