An electronic alert to reduce excessive prescribing of short-acting beta2-agonists for people with asthma in East London: a retrospective case-control study using routine primary care data

Abstract

Introduction: Computer decision support is increasingly used to reduce high-risk prescribing and improve asthma management. In 2015 an alert to identify excessive prescribing of short-acting beta₂-agonists (SABAs) was introduced in EMIS Web-using practices in England. This study evaluates its effect on SABA prescribing in asthma.

Methods: Patients aged 5-75 years with asthma (coded diagnosis and one SABA prescription/12 months), prescribed excessive SABAs (3 SABAs/90 days) were included. Data was extracted from 132 general practices between 2015-2016 (cases) and 2013-2014 (controls). SABA prescribing, asthma reviews and exacerbation data was extracted. Data was adjusted for age, gender and ethnicity. Subgroup analyses included prescription type and time point.

Results: 18,244 asthma patients were prescribed excessive SABAs. In the 12 months following the alert repeat SABA prescribing reduced by 6% (OR_adj 0.938, p<0.001). A reduction in SABA prescribing was associated with Black ethnicity (OR_adj 0.964, p<0.001) and South Asian ethnicity (OR_adj 0.972, p<0.001). The alert had no effect on exacerbations (OR_adj 0.988, p=0.561). On further analysis, at 3 months following the alert asthma reviews increased by 12% (OR_adj 1.120, p=0.002) and at 6 months repeat SABA prescribing reduced by 5% (OR_adj 0.951, p<0.001) and exacerbations reduced by 8% (OR_adj 0.924, p<0.001).

Conclusion: An alert can reduce SABA prescribing among asthma patients in primary care. A reduction appears to occur in response to an asthma review initiated following the alert rather than a change of SABA prescribing on alert presentation.