Abstract
The authors wish to thank the Asthma UK Centre for Applied Research for funding this work. AB is an National Institute for Health Research (NIHR) Senior Investigator and additionally was supported by the NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London. MT was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, NIHR School of Primary Care Research and NIHR Southampton Biomedical Research Centre. CG was supported by the NIHR CLAHRC North Thames at Bart’s Health NHS Trust.
Highlights
Asthma is a heterogeneous disease, usually characterised by (a) chronic airway inflammation with variable symptoms of wheeze, shortness of breath, chest tightness and/or cough, and (b) variable expiratory airflow limitation.[1]
Frequent and increasing use of short acting beta2-agonists (SABA) or reliever therapy is a marker for poor asthma control and increased risk of asthma attacks,[4] with control defined as the degree to which the manifestations of asthma are minimised by treatment.[5]
The National Review of Asthma Deaths identified that 39% of people who died from asthma had been prescribed more than 12 SABA inhalers in the year before death and 4% had been prescribed more than 50 SABA inhalers in the year before death.[15]
Summary
Asthma is a heterogeneous disease, usually characterised by (a) chronic airway inflammation with variable symptoms of wheeze, shortness of breath, chest tightness and/or cough, and (b) variable expiratory airflow limitation.[1]. Computer decision support systems (CDSSs) are increasingly being used to improve the prevention and management of chronic conditions such as asthma.[21, 22] CDSSs include electronic alerts and reminders that use patient-specific information and clinical data to help healthcare providers make decisions that enhance patient care.[21, 23] Whilst CDSSs have the potential to improve prescribing efficiency for healthcare professionals[24,25,26,27] overall effectiveness in clinical practice is unclear.[28] Recommendations have called for the electronic surveillance of prescription refill frequency in primary care to alert clinicians to patients being prescribed excessive quantities of SABA15; it is unclear to what extent alerts have been used in the management of SABA prescribing and what impact, if any, they have on patient outcomes. AIMS We aim to identify and critically appraise studies that have used electronic alerts to identify people with asthma being prescribed excessive SABA in primary care. Evaluate the effectiveness of electronic alerts within CDSSs to identify people with asthma being prescribed excessive SABA in primary care. Determine the features of electronic surveillance systems that have the potential to improve process outcomes for healthcare providers and clinical outcomes for people with asthma
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