RPS Conference 2010, Abstracts 2010 - Royal Pharmaceutical Society

21
Further investigations on GP prescribing and patient compliance of steroid inhalers for
Asthma and Chronic Obstructive Pulmonary Disease patients within a PCT in North West
England
Ian Cubbin, Andy McAlavey, Burns Wong
Liverpool John Moores University, Liverpool, United Kingdom
Focal Points
• Assessing patient’s usage of steroid inhalers dependent on the frequency of prescriptions and
their dosing regimen
• Approximately 12% of patients on a steroid inhaler in the study comply with their inhaler
prescription (+/- 10%)
• Compliance to steroid inhaler is poor, improved patient education is necessary to extend
therapeutic value
Introduction
The use of inhaled steroid is an integral part in the treatment of asthma (BTS guidelines Step 2
and onwards) and chronic obstructive pulmonary disease (COPD). Daily administration of
inhaled steroid acts as prevention to the exacerbation of attacks associated with the two airway
diseases 1 . Steroid inhalers accounted for over 577 million prescriptions in 2008, equivalent to
60.5% of the total Chapter 3 prescribing of the BNF 2 . This study investigated the trend in
compliance of these inhalers and discusses implications following previous work by Marsden
focusing on the same population 3 . The prescribing of Beclomethasone, the most common
steroid prescribed is discussed; and Seretide® is compared with Symbicort®, the only steroid
inhalers licensed in COPD 4 .
Method
The target population consisted of 87490 patients from 13 surgeries within the Primary Care
Trust (PCT). Computerised patient records of subjects with asthma or COPD prescribed a
steroid inhaler in 2009 were interrogated. The dates of the 3 most recent prescriptions were
recorded to determine the frequency and duration of the treatment according to the patients
dosing regimen. Compliance was calculated and potential discrepancies checked within the
patient history.
Results
The total number of patients prescribed a steroid inhaler in 2009 was 3943 compared to 4524 in
2008 (13% reduction); .partly accounted for by refinement of the tool and the removal of
patients prescribed for seasonal use. 3250 of the 3943 patients were prescribed 3 or more
times. 82 patients received ‘as directed’ dosing and were excluded. The compliance results
accounted from the remaining 3168 patients. Only 370 patients (11.7%) of the 3168 complied
with a 90-110% usage range of their inhalers compared with 773 patients (33%) last year. The
number of patients over-using their inhalers rose significantly this year. Interrogation of
prescribing patterns suggested alignment with 28 or 56 day ordering for oral drugs, and
increase in Smart prescribing which distorted the figures for Symbicort®. The decrease in
compliance of over 20% of the population was accounted for by both over and under usage, the
seasonal users having high compliance rates, and now excluded.