Case study

Background

• Over-reliance of short-acting beta-agonists (SABA) often indicates poor asthma control and is a predictor for future risk of asthma attack and death.
• The Scottish Therapeutics Utility (STU) tool uses data from GP health records to provide practice-level reports on repeat and high-risk prescribing.
• STU contains five searches relating to respiratory, including >12 SABA in 1 year, without a diagnosis of COPD’.
• STU is installed across Lothian, yet not every practice used it.
• We aimed to improve primary care prescribing of SABA in NHS Lothian, Scotland, by improving awareness of STU data.

Methods

• A training event raised awareness of STU and the ease at which high risk asthmatic patients could be identified.
• Practices were incentivised to analyse their data and review patients’ over-ordering SABA’s.
• We analysed SABA prescribing data extracted from STU before (June 2019) and after the intervention (May 2021).

Results

• Before the intervention, >12 SABA were prescribed to an average of 56 patients per practice (standard deviation (SD) 71).
• There was wide variation in prescribing: per practice, the minimum number of individuals receiving >12 SABA was 10; the highest was 602 patients.
• Following the intervention, the number of individuals receiving >12 SABA decreased with an average of 36 per practice and a reduction in variation between practices (SD 28). 

Lessons learned

• Although STU data was available prior to the intervention, few practices were aware of the benefits.
• Following the intervention, a reduction in the number of individuals who were prescribed >12 SABA per year was seen across all areas of the health board.

Messages for others

• We saw a reduction in SABA over-prescribing in NHS Lothian by promoting the use of primary care data to help educate and encourage practices to change prescribing.
• To see change, we needed to raise awareness directly with users.