De-implementing inappropriate inhaled steroids use in Dutch COPD patients in primary care

Abstract

In the Netherlands around 50% of primary care COPD patients use inhaled corticosteroids (ICS), 30% of these probably have no appropriate indication Aim is 10% reduction in ICS (+-LABA) prescriptions for COPD patients A controlled pre/post intervention study with an incomplete control group (media-exposure). The intervention consisted of 1. Education within the regular “Pharmacotherapy meeting” between GP’s and pharmacists, 2. Providing GP’s with a flow chart to decide if the patient could safely stop their ICS, 3. Providing GP’s with a list of patients that might be suitable for de-implementation (patients>55 years who used ICS and had not received courses of predniso(lo)ne in the last year). Medication prescription data was gathered (all patients >55 years who received >2 prescriptions for copd/astma in the preceding 12 months). ICS (+/-LABA), LABA/LAMA, predniso(lo)ne, antibiotics and topical antimycotics were obtained before and after intervention. Intervention group data were compared to the rest of the country There was a significant decrease (11.4%) in ICS – ICS/LABA prescriptions in the whole group, however without significant differences between intervention and control group. See table 1 The 11.4% decrease in ICS prescriptions seems to be a national trend. Active de-implementation can play a role in promoting this. Decrease in ICS in COPD patients use does not seem to be accompanied by an increase in exacerbations