Reducing SABA 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: Cross-sectional study using anonymised clinical and prescribing data from the primary care records in three contiguous east London boroughs. Methods: 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, co-morbidities and prescriptions for asthma medications. Results: In the study population of 30,694 people with asthma, 26% were prescribed ≥6 SABA inhalers in the previous year. A ten-fold variation between practices (<6% to 60%) was observed in the proportion of patients on ≥6 SABA inhalers/year. By converting both SABA and ICS to standard units we improved the accuracy of comparisons across different preparations. 25% of those taking ≥6 SABA/year were underusing ICS, this rose to 80% for those prescribed <6 SABA/year. Prescription modality was a strong predictor of SABA overprescribing, with repeat dispensing strongly linked to SABA overprescribing (OR 6.52, (95% CI 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 /year could potentially save up to 70% of asthma admissions a year within that group.