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

De Simoni, A; Hajmohammadi, H; Pfeffer, P; Cole, J; Griffiths, C; Hull, SA

Journal article

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

Abstract:: 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.
Results
In the study population of 30 694 people with asthma, >25% (1995/7980), were prescribed ≥6 SABA inhalers in the previous year. A 10-fold variation between practices (<6% to 60%) was observed in the proportion of patients on ≥6 SABA inhalers/year. By converting both SABAs and inhaled corticosteroids (ICSs) to standard units the accuracy of comparisons was improved across different preparations. In total, >25% of those taking ≥6 SABAs/year were underusing ICSs, this rose to >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.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

De Simoni, A., Hajmohammadi, H., Pfeffer, P., Cole, J., Griffiths, C., & Hull, S. A. (2022). Reducing short-acting beta-agonist overprescribing in asthma: lessons from a quality-improvement prescribing project in East London. British Journal of General Practice, 72(722), e619–e626.

MLA Style

De Simoni, A, et al. “Reducing Short-Acting Beta-Agonist Overprescribing in Asthma: Lessons from a Quality-Improvement Prescribing Project in East London.” British Journal of General Practice, vol. 72, no. 722, 2022, pp. e619–e626.

Chicago Style

De Simoni, A, H Hajmohammadi, P Pfeffer, J Cole, C Griffiths, and SA Hull. 2022. “Reducing Short-Acting Beta-Agonist Overprescribing in Asthma: Lessons from a Quality-Improvement Prescribing Project in East London.” British Journal of General Practice 72 (722): e619–e626.
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