# Reducing short-acting beta-agonist overprescribing in general practice: Evaluation of a quality improvement programme in East London

## TL;DR

A quality improvement program in East London reduced overprescribing of SABA inhalers for asthma patients using electronic alerts and collaborative practices.

## Contribution

A system-wide quality improvement program using electronic alerts and collaborative practice cultures effectively reduced SABA overprescribing.

## Key findings

- Electronic prescribing alerts reduced SABA overprescribing by 50% in patients who received an active response.
- Practices with collaborative cultures implemented improvement strategies more rapidly.
- The program was associated with a significant decrease in asthma patients prescribed more than 6 SABA/year.

## Abstract

Overprescribing of short-acting beta-agonist (SABA) inhalers is a worldwide problem.

To evaluate the impact of a system-wide quality improvement programme on SABA overprescribing, and to identify the most effective strategies.

All general practices within one East London borough received the intervention between October 2020 and March 2023. Practices in two neighbouring boroughs acted as comparators. Intervention practices engaged in quality improvement activities including: electronic alerts flagging patients prescribed ≥12 SABA inhalers/year; generating lists of patients overprescribed SABA to call for review; a summary guideline for clinicians; electronic patient information leaflets. All practices were offered webinar coaching. Prescribing data were collected from electronic health records, and SABA overprescription evaluated through interrupted times series analysis. Content analysis was applied to survey data and conversations with staff.

During the three-year study period all localities introduced programmes to reduce SABA prescribing. We observed a significant decrease in the proportion of asthma patients prescribed more than 6 SABA/year in the study practices. The COVID pandemic triggered a temporary increase in patients on asthma registers, which persisted for 6 months. When implemented by practices the electronic prescribing alerts were effective: 50% of patients who received an active response reduced to <12 SABA in the following year.

This quality improvement programme was associated with a reduction in SABA overuse, which could also decrease hospital admissions. Practices required individual coaching to use the electronic tools effectively. Integrated prescribing alerts reduced overprescribing, and collaborative practice cultures supported faster implementation of improvement strategies.

Using a learning health system built on electronic prescription data from primary care was associated with a reduction in short-acting beta-agonist (SABA) overprescribing.Prescribing alerts, integrated within the practice software, were associated with a reduction in overprescribing in the subsequent year.Localities which had a culture of general practices working together were able to implement quality improvement and other strategies more rapidly.

Using a learning health system built on electronic prescription data from primary care was associated with a reduction in short-acting beta-agonist (SABA) overprescribing.

Prescribing alerts, integrated within the practice software, were associated with a reduction in overprescribing in the subsequent year.

Localities which had a culture of general practices working together were able to implement quality improvement and other strategies more rapidly.