Reducing short-acting beta-agonist overprescribing in asthma: lessons from a quality-improvement prescribing project in East London

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Anna De Simoni¹  Hajar Hajmohammadi¹  Paul Pfeffer²  Jim Cole¹  Chris Griffiths¹  Sally A Hull¹ 

[1] Wolfson Institute of Population Health, Queen Mary University of London;Wolfson Institute of Population Health, Queen Mary University of London, London and Department of Respiratory Medicine, Barts Health NHS Trust

关键词: asthma;    electronic prescribing;    primary health care;   

DOI  :  10.3399/BJGP.2021.0725

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background Excess prescription and use of short-acting beta-agonist (SABA) inhalers is associated with poor asthma control and increased risk of hospital admission.Aim To quantify the prevalence and identify the predictors of SABA overprescribing.Design and setting A cross-sectional study using anonymised clinical and prescribing data from the primary care records in three contiguous East London boroughs.Method Primary care medical record data for patients aged 5–80 years, with ‘active’ asthma were extracted in February 2020. Explanatory variables included demography, asthma management, comorbidities, and prescriptions for asthma medications.Results25% (1995/7980), were prescribed ≥6 SABA inhalers in the previous year. A 10-fold variation between practices (80% (18 170/22 713), for those prescribed <6 SABAs/year. Prescription modality was a strong predictor of SABA overprescribing, with repeat dispensing strongly linked to SABA overprescribing (odds ratio 6.52, 95% confidence interval = 4.64 to 9.41). Increasing severity of asthma and multimorbidity were also independent predictors of SABA overprescribing.Conclusion In this multi-ethnic population a fifth of practices demonstrate an overprescribing rate of <20% a year. Based on previous data, supporting practices to enable the SABA ≥12 group to reduce to 4–12 a year could potentially save up to 70% of asthma admissions a year within that group.

【 授权许可】

Free