A "real-life" observational cost and effectiveness analysis of leukotriene receptor antagonist versus other add-on choices in primary care (REALL)
A team of researchers from the University of Aberdeen and GPIAG are recruiting GPs from across the UK to participate in an international study to look at the cost and effectiveness of various asthma treatments.
REALL is a real-life observational study, which has been designed in collaboration with the General Practice Airways Group (GPIAG). The study will look at patients with asthma and their responses to a change in medication. Funding has been provided by an unrestricted educational grant from Merck, Sharp and Dohme.
The REALL study is being led by Principal Investigator David Price, in his role as the GPIAG Professor of Primary Care Respiratory Medicine. The research team has begun recruiting GPs and nurses within the UK as new investigators, with the aim of collecting data by November 2003. REALL has become an international study, with five countries outside of the UK also preparing to take part. Spain and Portugal will begin collecting data later this year, while the Netherlands, Ireland and Canada will commence early in the New Year.
The prevalence of asthma is substantial in the UK, and its treatment has significant implications for the NHS. There are a wide range of treatments for asthma that differ in value, in terms of treatment outcomes and monetary costs. Consequently there is a need for health care research to investigate these outcomes and costs in "real life" situations within Primary Care. Issues such as compliance and decision-making processes of patients and GPs can be observed, along with economic evaluations of different treatments.
REALL aims to find which asthma treatments are most beneficial to both patients health, and the NHS in economic terms. As such, one of REALL's primary outcomes is the comparison of "asthma control days" when using a range of add-on asthma treatments.
Professor Price said: "With the REALL study, our team from the University of Aberdeen hope to understand the decision-making process employed by GPs with a special interest in asthma when making add-on choices and to explore the perceived needs of patients with asthma receiving add-on asthma therapy.
"We appreciate the huge pressures that GPs are under. REALL may be able to reduce some of this."
REALL aims to observe the 'real life' spectrum of patient response to 'add on' asthma medication. As such, the project team does not want to change the way GPs currently review and treat their patients. There is no randomisation of patients and there is no interference in GP's daily practice. The project team will, however, identify patients who may benefit from an asthma review, and can also undertake an asthma audit for the practice.
The REALL team, along with GPs within the GPIAG, are developing an electronic template to collect the minimum data set for asthma. This template contains all of the new contract quality indicators for asthma, and is designed to work on electronic practice management systems used within GP's surgeries. Currently REALL have a working asthma template for the EMIS system, and there will be electronic asthma templates for Vamp Vision, Torex and GPASS in operation by December. This is great news for GPs; it means that whatever system the practice uses, REALL can provide an electronic asthma template that operates in conjunction with existing software, and will enable GPs to collect all of the new contract quality indicators for asthma.
Within the new GP contract there are 117 points linked to the care of asthma and COPD, which could earn practices up to £2925 per GP in 2004/5. As a process of the study, GPs will collect data by completing the REALL asthma template (it does not contain any of the quality indicators for COPD.) This asthma template could help GP practices achieve their targets within the new contract, by achieving all of the asthma quality indicators, thus ensuring they are awarded the maximum payment for each asthma patient.
Many GPs are obviously concerned about the new contract and its implications in general practice. In support of this issue there is a meeting, coordinated by the GPIAG, on November 20th, 2003 in Manchester. The meeting will enable GPs, respiratory nurses and practice managers to discuss ideas and resources that may help their practices achieve their targets. The aim of the meeting is to focus realistically on how available resources can be utilised cost-effectively, whilst improving health care. Along with this meeting, two others are being planned in the New Year, at different lcoations. For further details please contact, GPIAG Committee Member, Dr Hilary Pinnock, e-mail: Hilary.Pinnock@gp-g82071.nhs.qquk
If you would like to take part in the REALL study or would like more information, please contact Joanne Kirkland, Research Assistant, Department of General Practice and Primary Care, University of Aberdeen, telephone: (01224) 550920, or email: j.kirkland@abdn.ac.uk