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September 10, 2020
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Electronic alert may reduce excessive prescribing of short-acting asthma relievers

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An automatic electronic computer alert for general practitioners helped identify and reduce excessive prescribing of short-acting beta agonists for patients with asthma.

The automatic electronic alert was introduced on general practitioners’ computer systems in 2015. The alert pops up when patient medical records identify three SABA prescriptions in a 3-month period and then suggests an asthma review to assess symptoms and improve asthma control.

Asthma medications
Source: Adobe Stock.

“While computer decision support is increasingly used to reduce high-risk prescribing and improve asthma management, the evidence to support the use of a simple single-component alert intervention in the identification and management of excessive SABA prescribing is unclear,” Shauna McKibben, PhD, allergy and asthma nurse specialist at Asthma U.K. Center for Applied Research at Queen Mary University and Imperial College Healthcare NHS Trust, London, said during a presentation at the virtual European Respiratory Society International Congress. “This study aimed to determine the impact of an electronic alert at reducing excessive SABA prescribing among people with asthma in primary care.”

Researchers conducted a retrospective, case-control study of patients with asthma aged 5 to 75 years who were prescribed at least one SABA in a 12-month period. Data on SABA prescribing, asthma reviews and exacerbations were extracted from 132 general practices in northeastern London from 2013 to 2014 (before the alert) and from 2015 to 2016 (after alert initiation) for comparison.

Shauna McKibben
Shauna McKibben

In total, 18,244 patients (mean age, 42.1 years; 55.2% female) with asthma were prescribed excessive SABAs, which the researchers defined as at least three SABAs within 90 days.

Twelve months after initiation of the automatic electronic alert, researchers observed a 6% reduction in repeat SABA prescription (adjusted OR = 0.938; P < .001). The alert led to a significant reduction in SABA prescription among patients who were Black (aOR = 0.964; P < .001) and South Asian (aOR = 0.972; P < .001). The researchers observed no effect on asthma exacerbations with the electronic alert (aOR = 0.988; P = .561).

Asthma reviews increased by 12% 3 months after initiation of the automatic electronic alert (aOR = 1.12; P = .002) and repeat SABA prescribing reduced by 5% at 3 to 6 months (aOR = 0.95; P < .001), with an 8% reduction in asthma exacerbations (aOR = 0.92; P < .001). Repeat SABA prescribing decreased by 9% at 6 to 12 months after alert initiation (aOR = 0.91; P < .001).

“A simple electronic alert identifying excessive SABA prescribing can prompt a review of asthma control and lead to a reduction in SABA prescribing,” McKibben said. “Reviewing alerted patients is imperative to aid a reduction in excessive SABA prescribing to improve asthma control and reduce the risk of asthma exacerbation.”

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