Feedback of actionable individual patient prescription data to improve asthma prescribing: pragmatic cluster randomised trial in 233 UK general practices

BACKGROUND: Potentially inappropriate prescribing (PIP) of asthma bronchodilator inhalers is associated with increased morbidity and mortality. AIM: To evaluate the effectiveness of feedback on the PIP of bronchodilator inhalers. DESIGN AND SETTING: Pragmatic cluster randomised trial involving 235 of 244 (96.3%) GP practices in one Scottish health board. METHOD: Practices were randomly allocated (1:1 ratio) to individualised feedback (including visualised medication histories for each patient and action-oriented messages) on PIP of bronchodilator inhalers from prescription data; feedback reports were sent in July 2015, February 2016, and August 2016. Controls were sent feedback on an unrelated subject. The primary outcome was the change in the mean number of patients per practice with PIP of bronchodilator inhalers from the baseline period (August 2014–July 2015) until the post-feedback period (February 2016–January 2017), identified through a composite of five individual measures using prescription data. RESULTS: In the analysis of the primary outcome, the mean number of patients with PIP of bronchodilator inhalers fell in the 118 practices that were sent feedback from 21.8 per practice to 17.7 per practice. Numbers fell marginally in the 115 control practices, from 20.5 per practice to 20.2 per practice, with a statistically significant difference between the two groups. There were 3.7 fewer patients per practice with PIP of bronchodilator inhalers in the intervention practices versus the control practices (95% confidence interval = −5.3 to −2.0). CONCLUSION: Individualised feedback of PIP of asthma bronchodilators that included background information, visualised medication histories for each patient, and action-oriented messages was effective at reducing the number of patients exposed to excess or unsafe prescribing of bronchodilator inhalers.