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Rationale Audit and feedback is an evidence-based implementation strategy, but studies reporting the use of theory to guide design elements are limited. Aims and ObjectivesWithin the context of a programme of research aiming to improve the implementation of supported asthma self-management in UK primary care (IMPlementing IMProved Asthma self-management as RouTine [IMP2ART]), we aimed to design and develop theoretically-informed audit and feedback that highlighted supported asthma self-management provision and areas for improvement in primary care general practices. Method Aligned with the Medical Research Council (MRC) complex intervention framework, the audit and feedback was developed in three phases: (1) Development: literature and theory exploration, and prototype audit and feedback design; (2) Feasibility: eliciting feedback on the audit and feedback from general practice staff (n = 9); (3) Prepiloting: delivering the audit and feedback within the IMP2ART implementation strategy (incorporating patient and professional resources and an asthma review template) and eliciting clinician feedback (n = 9). Results Audit and feedback design was guided by and mapped to existing literature suggestions and theory (e.g., Theoretical Domains Framework, Behaviour Change Technique Taxonomy). Feedback on the prototype audit and feedback confirmed feasibility but identified some refinements (a need to highlight supporting self-management and importance of asthma action plans). Prepiloting informed integration with other IMP2ART programme strategies (e.g., patient resources and professional education). Conclusion We conclude that a multistage development process including theory exploration and mapping, contributed to the design and delivery of the audit and feedback. Aligned with the MRC framework, the IMP2ART strategy (incorporating the audit and feedback) is now being tested in a UK-wide cluster randomised controlled trial.

Background Electronic templates are frequently used in long-term condition reviews (e.g. asthma) to act as reminders and improve documentation, however, they can restrict patient-centred care and opportunities for patients to discuss concerns and self-management.Aim The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) programme aimed to develop a patient-centred asthma review template that encourages supported self-management.Design & setting This was a mixed-methods study, which integrated qualitative and systematic review data, primary care Professional Advisory Group feedback, and qualitative data from clinician interviews.Method Aligned with the Medical Research Council complex intervention framework, a template was developed in three phases: 1) Development phase: qualitative exploration with clinicians and patients, a systematic review, and prototype template development; 2) Feasibility pilot phase: feedback from clinicians (n=7); 3) Pre-piloting phase: delivering the template within the IMP2ART implementation strategy (incorporating the template with patient and professional resources) and eliciting clinician feedback (n=6).Results Template development was guided by the preliminary qualitative work and the systematic review. A prototype template was developed with an opening question to establish patient agendas, and a closing prompt to confirm agendas have been addressed and an asthma action plan provided. The feasibility pilot identified refinements needed, including focusing the opening question to asthma. Pre-piloting ensured integration with the IMP2ART strategy.Conclusion Following the multi-stage development process, the implementation strategy including the asthma review template is now being tested in a cluster randomised controlled trial.

Healthcare providers recognise the value of quality improvement (QI) activities that enhance the care received by service users. QI is particularly effective for the management of long-term conditions requiring linked care. However, starting and sustaining QI programmes in practice can be time-consuming and difficult and may produce inconclusive and/or inconsistent results. As a not-for-profit social enterprise, Optimum Patient Care (OPC) has been delivering effective and sustainable QI since 2005 in healthcare systems in several countries.This paper provides a roadmap for the implementation of collaborative QI programmes in a range of settings across three countries. It summarises the barriers we have experienced in the QI cycle and solutions we have identified in our history of working with healthcare providers to deliver QI programmes in primary and secondary care. Key lessons include the strategic involvement of partners in the fields of medicine, health IT, data science and epidemiology, to harness, understand and act on the insights gained from patient and practice electronic health data (EHR) alongside crucial input from patients and practicing clinicians themselves.QI aims resource-poor healthcare providers to increase the precision of identifying key patient groups requiring further follow-up – such as those at risk of worsening health outcomes using risk prediction tools. Parallel goals are to increase the proportion of patients receiving prompt and appropriate treatment and to increase patient engagement. We achieve this by providing customised software tools and disease management algorithms to our healthcare partners to allow for automation of aspects of QI that have traditionally involved a manual process. Sharing our experience of these methods helps to embed a sustainable programme of QI in many systems in varied settings.

INTRODUCTION: Female sex steroid hormones have been implicated in sex-related differences in the development and clinical outcomes of asthma. The role of exogenous sex steroids, however, remains unclear. Our recent systematic review highlighted the lack of high-quality population-based studies investigating this subject. We aim to investigate whether the use of hormonal contraception and hormone replacement therapy (HRT), subtypes and route of administration are associated with asthma onset and clinical outcomes in reproductive age and perimenopausal/postmenopausal females.METHODS AND ANALYSIS: Using the Optimum Patient Care Research Database (OPCRD), a national primary care database in the UK, we will construct a retrospective longitudinal cohort of reproductive age (16-45 years) and perimenopausal/postmenopausal (46-70 years) females. We will estimate the risk of new-onset asthma using Cox regression and multilevel modelling for repeated asthma outcomes, such as asthma attacks. We will adjust for confounding factors in all analyses. We will evaluate interactions between the use of exogenous sex hormones and body mass index and smoking by calculating the relative excess risk due to interaction and the attributable proportion due to interaction. With 90% power, we need 23 700 reproductive age females to detect a 20% reduction (risk ratio 0.8) in asthma attacks for use of any hormonal contraception and 6000 perimenopausal/postmenopausal females to detect a 40% (risk ratio 1.40) increased risk of asthma attacks for use of any HRT.ETHICS AND DISSEMINATION: We have obtained approval (ADEPT1317) from the Anonymised Data Ethics and Protocol Transparency Committee which grants project-specific ethics approvals for the use of OPCRD data. Optimum Patient Care has an existing NHS Health Research Authority ethics approval for the use of OPCRD data for research (15/EM/150). We will present our findings at national and international scientific meetings and publish the results in international peer-reviewed journals.TRIAL REGISTRATION NUMBER: EUPAS22967.