IMPlementing IMProved Asthma self-management as RouTine (IMP2ART)

IMP2ART

Patient / Population Intervention / Exposition Vergleich Endpunkt

In 144 UK general practices with 51,335 patients with asthma, the IMP2ART whole-systems implementation strategy did not reduce unscheduled asthma care in the second year after randomisation compared with usual asthma care.

N

51.335Patienten

Design

Parallel-group, cluster randomised hybrid type II implementation trial in UK general practices. The strategy is a facilitation workshop, audit and feedback, an asthma review template, professional training and patient resources

Endpunkt

Unscheduled asthma care between 12 and 24 months after randomisation, from routine data; co-primary implementation outcome of an asthma action plan recorded as provided or updated in the previous two years, assessed at 24 months from routine data (revised before analysis from questionnaire-reported ownership at 12 months in the August 2026 protocol update)

Relevanz

2Wichtig — eine von mehreren Säulen.

ErgebnisAt least one unscheduled asthma care event in the second year 23.6% vs 22.6% (OR 1.06, 95% CI 0.93-1.21; P = 0.33); an asthma action plan on record as provided or updated, at 24 months, 84.0% vs 84.1% (OR 1.05, 95% CI 0.76-1.45; P = 0.75); no difference on any other outcome. 144 practices randomised (73 vs 71, seven lost), 28,488 vs 22,847 patients analysed; unscheduled care rose in both arms from a pandemic-era baseline of 17.3%.

Pinnock H, Hammersley V, Appiagyei F, et al. Presented at ERS Congress 2026, ALERT 1, 6 September. Not yet published.

Diskussion & Kritik

Thirty-five years of guidelines recommending supported self-management, and a facilitated, practice-wide strategy to deliver it changed nothing that routine data can see: unscheduled care and recorded action-plan provision ended indistinguishable, with an action plan on record for 84% of patients in both arms at two years because English financial incentives got there first. The trial recruited through the pandemic and measured a low-risk population in which there was little unscheduled care to prevent. A clean negative for the strategy as delivered, and evidence that health-system policy, not practice-level facilitation, sets the ceiling.