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

Background: Overprescribing of short-acting beta-agonist (SABA) inhalers is a worldwide problem. Objectives: To evaluate the impact of a system-wide quality improvement programme on SABA overprescribing, and to identify the most effective strategies. Methods: 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. Results: 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. Conclusions: 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.