Both asthma and COPD are common chronic obstructive pulmonary diseases that cause cough and shortness of breath. ICS are effective for asthma, but have limited effect in COPD, only in patients with 2 or more exacerbations per year and an inflammatory component such as asthma. Still, ICS is still very frequently prescribed. In addition to the lack of benefit, they also cause side effects.
This project aimed to reduce unnecessary ICS in patients with COPD with relatively good lung function and without asthma.
A controlled before-after study with two intervention groups and two evaluation moments. The control group is affected since the de-implementation has received widespread media-attention during the study.
Using focus groups with patients and care professionals, the project team identified barriers and facilitators for de-implementation and determined the best way to explain to patients with COPD that they can stop with ICS. This was integrated in the existing Pharmaco Therapeutic Meetings with general practitioners (GPs) and pharamacists.
The de-implementation started with training of general practitioners and pharmacists during a pharmaco-therapeutic meeting. For every GP, a list of their patients that may be receiving ICS unnecessarily was created by the pharmacists. All GPs received an overview of the criteria for stopping ICS. After a year, the pharmaco-therapeutic meeting groups received a reminder education and the GPs and pharmacists were asked to complete a survey on their experiences.
Both patients and care professionals were enthusiastic about reducing unnecessary ICS. GPs reported a lack of time as the most important barrier for de-implementation. There was a statistically significant reduction in ICS and ICS/LABA use after de-implementation compared to before in the entire group (both intervention and control). There was also a small reduction in dual bronchodilators and prescriptions for antibiotics and prednisolone.
The use of ICS can be reduced in patients with COPD without an increase of the number of exacerbations. This reduction is a national trend, and cannot be attributed to the de-implementation strategy.
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