Project: ARRISA-UK

At-Risk Registers Integrated into primary care to Stop Asthma crises in the UK

ARRISA-UK logoARRISA-UK is a randomised controlled trial of GP practice staff training and high risk patient identification and flagging to reduce the occurrence of severe asthma related events.

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Preventable hospital admissions

Unfortunately, far too many patients with asthma are admitted to hospital (approximately 72,000) or die (approximately 1150) unnecessarily in the UK every year.

We have excellent drugs available for asthma and clear advice on prescribing them that should allow asthma to be controlled in most patients.

It is known that certain asthma patients are at greater risk of being admitted or dying than others and that targeting intensive support and care to these patients improves their health.


Flagging people at risk – and learning how to help

We have undertaken a study that identified ‘at-risk’ patients within GP practices and used computer-based systems to create pop-up alerts when these patients contact the practice. Practice staff were trained on what to do when they see the alert.

This didn’t reduce the total number of attacks but reduced the hospital admissions as more patients appeared to receive appropriate treatment for their asthma.

Based on these promising findings we wish to undertake a nationwide study to confirm that we can improve the care of these patients without costing the NHS too much or affecting the care of other asthma patients within GP practices.

What are we doing about it?

We will identify patients who are at risk of having severe asthma attacks from GP practices in six regions within the UK, by searching their practice records for factors that predict risk of attacks.

In half of the GP practices, a pop-up alert will appear on the computerised medical notes whenever any of the ‘at-risk’ patients make contact with anyone in the practice. This alert will, for example, remind receptionists to book urgent appointments, GPs and nurses to advise patients to take their medication and follow their written asthma action plans and pharmacists to ensure patients take their medicines.

All practice staff will receive training on how to respond to the alerts, supported by web-based resources and practice study champions, with reminders at 6 weeks and 6 months.

We will use data available routinely from the GP practice and will not need to collect information directly from patients for our study.

After 12 months, we will count how many patients attended Accident and Emergency, had a hospital admission, or died due to asthma in each group.

We will also find out how many people have well controlled asthma, what medications are prescribed for asthma, how often patients attend routine appointments and if they stop smoking.

We will calculate how much this costs and whether it improves (or interferes with) the care of other patients with asthma in the practice.

We will work out which patients gain the most from our study. With their permission, we will arrange focus groups and interview for patients and staff, to discuss their thoughts about the at-risk registers and the training and how it worked in practice. 

Key People

Andrew Wilson Headshot
Andrew Wilson
Lead: Preventing asthma attacks
Gary Barton Headshot
Gary Barton
Professor of Health Economics, University of East Anglia
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Allan Clark Headshot
Allan Clark
Senior Lecturer in Medical Statistics, University of East Anglia
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Chris Griffiths
Centre Director, Lead: Preventing asthma attacks
Stan Musgrave
Stan Musgrave
Research Fellow
Mike Noble
General Practitioner, Acle Medical Partnership
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Helen Paynter Headshot
Helen Paynter
Public and Patient Involvement Representative
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Hilary Pinnock Headshot
Hilary Pinnock
Lead: Optimising management of asthma attacks, Lead: Postgraduate Training, Network Coordinator
David Price Headshot
David Price
Professor of Primary Care Respiratory Medicine
Aziz Sheikh Headshot
Aziz Sheikh
Centre Director
Jane Smith
Jane Smith
Senior Lecturer in Primary Care
Ann-Marie Swart Headshot
Ann-Marie Swart
Professor of Epidemiology, Director of the Norwich Clinical Trials Unit, University of East Anglia
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Mike Thomas
Mike Thomas
Professor of Primary Care Research
Samantha Walker Headshot
Samantha Walker
Deputy Chief Executive of Asthma UK
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Dec 2014 – Nov 2018

How can I get involved?

Find out more from the ARRISA-UK team.

ARRISA-UK website

Contact us

ARRISA-UK study team
Clinical Trials Unit
Norwich Medical School
University Of East Anglia
Norwich, NR4 7TJ

01603 593 309

Trial Registration

The ARRISA-UK study is registered with Controlled Clinical Trials: ISRCTN95472706

The ARRISA-UK study is also registered on the UK Clinical Research Network: Study ID=18118.


NHS' National Institute for Health Research's Health Technology Assessment Programme (NIHR HTA)

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