HWE ICB was the highest prescriber of high dose inhaled corticosteroids (ICS) for several years. Closer examination of high dose ICS prescribing rates by GP practice showed a significant disparity across the ICB; the lowest prescribing rate of high dose inhaled corticosteroid was 10.87% compared to the highest at 42.67% as of end March 2023.
Being a national outlier for high dose ICS prescribing rates raised concern as there is significant risk of harm from long term prescribing of high dose ICS coupled with a limited role in therapy in asthma and COPD with risks potentially outweighing benefits for most patients.
A quality improvement indictor aimed at reviewing asthma and COPD patients prescribed high dose ICS was included in the HWE ICB General Practice Enhanced Commissioning Framework (GP ECF) for 20232/20243.
As a result of a whole system approach dramatic reductions in high dose ICS prescribing has been achieved across the ICB resulting in more respiratory patients receiving optimised treatment and reducing risk of harm. 79 out of 129 practices reached or maintained the target ICS prescribing rate of 20% or less and another 46 reduced rates from baseline.
