Impact of health care professional training on adolescent hay fever: cluster randomised controlled trial of a complex intervention in primary care
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Date
04/07/2015Author
Hammersley, Victoria Suzan
Metadata
Abstract
Background
Hay fever is typically poorly managed, particularly in adolescents, in whom it is
responsible for considerable morbidity and impairment in educational performance.
Evidence-based training of professionals has the potential to improve outcomes, but
it can be expensive and so warrants formal evaluation. This trial sought to evaluate
the effectiveness of a training intervention for primary care-based health care
professionals on adolescent disease-specific quality of life.
Methods
A cluster randomised controlled trial was conducted in UK general practices.
Practices were centrally randomised to a short, intensive training course on the
evidence-based management of hay fever (intervention arm) or distribution of
guidelines (control arm). The primary outcome measure was the change in the
validated Rhinoconjunctivitis Quality of Life Questionnaire with Standardized
Activities (RQLQ(S)) score in adolescents with hay fever between baseline and six
weeks post-intervention (minimal clinically important difference = 0.5). Secondary
outcome measures included health care professionals’ knowledge and confidence in
managing hay fever, number of hay fever-related consultations, relevant treatments
prescribed and symptom scores. Multi-level modelling using a random effects model
was used to take account of between and within cluster variation, adjusting for strata,
individual covariates and year of study.
Results
Thirty-eight general practices were randomised (20 in the intervention arm) and
246/341 patients (50.2% male, mean age 15 years) were included in the primary
outcome analysis. Health care professionals’ self-assessed knowledge and confidence
improved (prescribing/recommending treatment mean score 95% CI 1.4, 2.8), and
the training was perceived to be of value. This did not however result in clinically or
statistically significant improvements in RQLQ(S): -0.15, 95% CI -0.52 to +0.21.
There were no differences in consultation frequency (95% CI -0.02, +0.63),
treatments issued for hay fever (95% CI -0.24, +0.08) or symptom scores (95% CI -
1.03, +0.54).
Conclusions
Although attendance on this short, intensive hay fever training course was associated
with professionals’ increased self-assessed confidence and understanding of the
clinical management of hay fever, this did not translate into improvements in
disease-specific quality of life or reduction in rhinitis symptoms in adolescents with
hay fever.