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 bronchodilator inhaler PIP. DESIGN AND SETTING: Pragmatic cluster randomised trial in 235/244 (96%) GP practices in one Scottish health board. METHOD: Random allocation of practices (1:1 ratio) to individualised feedback (including visualised medication histories for each patient and action orientated messages) on bronchodilator inhaler PIP from prescription data; sent July 2015, February 2016 and August 2016. Controls sent feedback on an unrelated subject. The primary outcome was the change from the baseline period (August 2014 to July 2015) to post-feedback period (February 2016 to January 2017) in the mean number patients per practice bronchodilator inhaler PIP identified by a composite of five individual measures using prescription data. RESULTS AND CONCLUSION: In the analysis of the primary outcome, the mean number patients with bronchodilator inhaler PIP fell in the 118 practices sent feedback (21.8 per practice to 17.7) and fell marginally in the 115 control practices (20.5 per practice to 20.2), with a statistically significant difference between the two groups (3.7 fewer patients per practice with bronchodilator PIP in intervention practices versus control, 95%CI -5.3 to -2.0). Individualised feedback of asthma bronchodilator PIP that included background information, visualised medication histories for each patient and action orientated messages was effective at reducing the number of patients exposed to excess or unsafe prescribing of bronchodilator inhalers.