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The use of electronic alerts in primary care computer systems to identify the excessive prescription of short-acting beta2-agonists for people with asthma: a systematic review

Shauna McKibben, Anna De Simoni, Andy Bush, et al.
npj Prim Care Respir Med 2017;28:14

Asthma is the most common long-term condition in the UK, with a prevalence of 6% in 2016–17. Approximately 5.4 million people currently receive treatment for the condition in the UK, and in 2015–16 there were an estimated 1.4 million asthma-related admissions to hospital in England and Wales. Of 195 deaths from asthma between 2012 and 2013, the National Review of Asthma Deaths (NRAD) reported that 39% of these patients had been prescribed more than 12 short-acting beta2-agonist inhalers (SABAs) in the previous year, and 4% had been prescribed more than 50.

Given that patients with good asthma control have less need for SABAs and require no emergency visits, it was recommended, after the publication of NRAD, that there be an electronic surveillance of SABA-prescription-refill frequency to alert clinicians to overuse. McKibben and colleagues from Asthma UK Centres for Applied Research in London and Southampton undertook a systematic review of MEDLINE, CINAHL, Embase, Cochrane and Scopus databases for randomised controlled trials between 2001 and 2015 using electronic alerts to signal SABA overuse in primary care.

They screened 2,035 articles and four trials involving both adults and children, and only included computer support systems that incorporated an alert initiated by excessive prescribing or dispensing of SABAs for asthma. The analysis found that electronic alerts, when delivered as a multicomponent intervention in an integrated healthcare system, have the potential to successfully identify and reduce excessive SABA prescribing. Due to variations in healthcare systems, intervention design and outcomes measurements in the studies considered, further research is needed to establish optimal design of alerting systems.

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