Abstract

Woodingdean Medical Centre is a medium sized practice on the edge of Brighton in East Sussex. I identified a need to review prescribing of inhalers in asthma. We met as a team of 4 nurses and one GP to review current prescribing practice, asthma review format and current guidance. We chose GINA guidance as an up-to-date simplified protocol, that allowed for accurate diagnosis and management. We used the Greener Practice Asthma Toolkit to audit our work.
We held regular educational sessions, sharing learning and reviewing cases. We used PCIT searches to identify at risk patients with asthma or suspected asthma.
Within 2 years we had improved prescribing by reducing the number of patients on SABA alone, identifying those with suspected asthma and systematically reaching a diagnosis, and offered MART or AIR therapy to eligible patients.
Feedback from patients and clinicians was that a greater understanding of the condition allowed for clarity on diagnosis, improved self management and better prescribing.
I used Openprescribing to monitor prescribing data in real time, which showed a steady and maintained trend towards less SABA prescribing, increased ICS prescribing, without an increase in high dose ICS prescribing. This conferred a reduction in carbon cost of inhalers by offering patients a choice to use a combination inhaler and offering DPI format.
The success of this transformation relied on a strong educational component and process for clinician feedback. Clinicians reported that having a strong basis in the latest guidance and research empowered them and patients to embrace new and better ways of treating asthma, and gave the team the momentum to bring patients and colleagues with them, within the practice and more widely within the PCN.