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Title: The use of an electronic alert to reduce excessive prescribing of short-acting beta2-agonists for people with asthma in primary care in East London : a mixed methods study
Author: McKibben, Shauna
ISNI:       0000 0004 9355 8387
Awarding Body: Queen Mary University of London
Current Institution: Queen Mary, University of London
Date of Award: 2020
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The excessive prescribing of short-acting beta2-agonists (SABAs), an indicator of poorly controlled asthma and a risk factor for asthma attacks, remains problematic despite proliferating guidelines for the management of asthma in primary care. Computer decision support alerts are increasingly used to influence prescribing behaviour with guidelines recommending clinicians are alerted to excessive SABA prescribing and patients subsequently invited for a review of asthma control. The aim of this thesis was to determine the effect of an alert to reduce excessive SABA prescribing and explore the potential reasons for the alert’s success or failure. Phase 1 of the thesis involved a systematic review of the literature on the use of electronic alerts to reduce excessive SABA prescribing in primary care. Findings showed limited evidence to support the use of an alert to reduce excessive SABA prescribing when delivered as part of a multicomponent intervention in an integrated healthcare system. Using a retrospective case-control study design, Phase 2 explored the effect of a single component alert to reduce SABA prescribing in 132 practices across three Clinical Commissioning Groups in east London. Findings showed a small, potentially clinically significant 6% reduction in repeat SABA prescribing within 12 months of the SABA alert (P<0.001). Phase 3 consisted of qualitative research with asthma experts and primary care staff (n=32), to explore the use of an alert to identify excessive SABA prescribing in practice. Using the ‘framework’ analysis approach, findings showed varying definitions and perceptions of excessive SABA use and inconsistent alert use, influenced by suboptimal design and ambiguous action. Inconsistencies in how excessive SABA prescribing is defined, identified and managed by clinicians in practice were observed. Findings show that alerts to improve SABA prescribing practice have potential to improve asthma management and clinical outcomes for people with asthma in primary care. Further research is required to determine the impact of an alert on SABA prescribing when optimised and delivered in a multicomponent intervention. Future alert interventions require a collaborative effort between people with asthma, general practice and wider primary care.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available