IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) in primary care: internal pilot for a cluster randomised controlled trial

Introduction: IMP2ART is a multidisciplinary, theoretically-informed strategy to improve the implementation of supported self-management and asthma outcomes in routine primary care in the United Kingdom. The strategy includes 1) patient resources to support self-management 2) professional education for general practice staff 3) organisational strategies (audit and feedback and an asthma review template). This pilot, internal to a cluster randomised controlled trial, aimed to test trial processes and recruitment feasibility, and to understand practices’ likely engagement with IMP2ART.

Method: A mixed-method pilot was conducted in 12 general practices (May-September 2021). Practices were randomised to the IMP2ART implementation arm (n=6), or usual care control (n=6). Recruitment and set-up processes were monitored, with quantitative data analysed on key aspects of IMP2ART delivery (asthma review template uploads, audit and feedback reports sent, IMP2ART workshops held) and practice response (patient website views, education module completion). 10 qualitative interviews were conducted with implementation arm staff and IMP2ART facilitators. Interviews were analysed using framework analysis.

Results: We recruited 12 practices to the study, one control practice withdrew. We delivered the strategy as planned; the review template was successfully uploaded, the annual audit report was sent, and practice workshops were held in all implementation practices (attendance ranged from 7-31). There were minor delivery delays for some monthly audit and feedback reports. Practice response analysis indicated ≈450 unique page views on the resource website, and 100% of practices completed the team education. Interview data were largely positive, with examples of how practices were using IMP2ART.

Discussion: The IMP2ART trial processes were successful and required only minor changes. Practices engaged with the implementation strategy and its resources, suggesting that IMP2ART is acceptable and feasible.