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The UK's primary care sustainability network

5. Identifying SABA over-reliance at prescription requests

When a patient requests a prescription for a SABA inhaler, it’s helpful for the staff member actioning the request to identify whether the patient is experiencing or is at risk of SABA over-reliance. This project suggests ways in which this information can be made easily available to staff.

The process

Step 1: Identify which staff action prescription requests

This may be receptionists, nurses, dispensary staff, pharmacists or doctors.

Step 2: Show staff how to identify SABA over-reliance

The Primary Care IT guide shows how to check SABA use and adherence to ICS. It can be taught in a brief training session and then kept accessible for reference. Staff should check for SABA over-reliance at the time of actioning the prescription request. The flowchart shows how to act based on findings.

Resources:

Step 3: Issue prescription and provide information about SABA over-reliance

If the patient has received 6 or more SABA in the last 12 months, then issue the prescription and add a script note about SABA over-reliance. Send the patient information about SABA over-reliance by SMS.

You may wish to go further than the IIF indicators and include all patients using 3 or more SABA in 12m as this level of use is associated with poorer control.

Resources:

  • Example script note for SABA over-reliance:“If you need your reliever (salbutamol) inhaler 3 or more times in a week, or use 3 or more inhalers in a year, this could mean your asthma treatment needs improving. Please make an appointment with the nurse/ doctor to discuss.”
  • SMS: Information on good asthma control (see below)
  • Patient information leaflet on SABA over-reliance
  • PCRS slide rule
Step 4: Invite patient to Asthma Review Consultation

Issue an invitation to the patient to book Asthma Review Consultation to review management.

Resource:

  • SMS/ Letter Invitation: patients with SABA over-reliance (see below)
Alternative step 4: Highlight SABA over-reliance on the patient record

Alternatively, set a visibility alert to highlight that the patient is affected by SABA over-reliance so that this can be addressed at future contacts.

Resource:

Resources

SMS templates

Invitation for patients with SABA over-reliance

SMS
It looks like you have needed 6 or more blue inhalers in the past year – this may mean that your asthma treatment needs improving. Please book an asthma review.

AccuRx SMS
It looks like you have needed 6 or more reliever (blue) inhalers in the past year – this may mean that your asthma treatment needs reviewing. Please book an asthma review.
To learn more, please see [insert link here].

Letter templates

Invitation for patients with SABA over-reliance

Dear Patient,

Our records show that your asthma may not be well controlled, and you could be at risk of future asthma attacks. This is because you have needed 6 or more reliever (blue) inhalers in the past year which can be a sign that someone’s asthma treatment needs improving. Please contact us to book an asthma review so that we can help ensure you are receiving the right treatment.

To learn why needing many blue inhalers is an indication that your asthma control may be poor and you could be at risk of an asthma attack, please see this leaflet here.

This website explains how to get the most out of your review:

https://www.asthma.org.uk/advice/manage-your-asthma/adult-review/

For information about inhalers and the environment, please see this leaflet here.

We look forward to seeing you soon for your asthma review. Please remember to bring these things to your appointment: your inhalers and spacer, your Personalised Asthma Action Plan and your peak flow meter.

Many thanks,

[Practice name/ lead clinician]