Letters in Addition to Emailed Audit and Feedback in Refining Asthma Treatment in Primary Care

Public Health England have estimated that 36,000 excess deaths occur each year due to UK air pollution. Respiratory inhalers produce 3% of NHS greenhouse gas production. The two main inhaler device categories are pressurised Metered Dose Inhalers (pMDIs) and Dry Powder Inhalers (DPIs). The chemical propellant in pMDIs is the majority cause of inhaler carbon footprint, with pMDIs having an 18 times higher carbon footprint than DPIs. The rates of asthma in the UK population are amongst the highest worldwide and its mortality rate remains amongst the worst in Europe.A pre-existing Audit and Feedback (A&F) quality improvement project (QIP) is being undertaken by NHS West Yorkshire Integrated Care Board (ICB) with the aim of improving asthma outcomes and reducing the environmental impact of inhalers in primary care. The A&F being utilised here has been validated locally in two peer reviewed studies and is now standard practice in the region. There is convincing evidence that A&F has a positive effect on enacting behaviour change, especially where behaviour change is related to prescribing with low baseline compliance with guidelines. However, the evidence base is poor on which design features of A&F produce enhanced results. There is supporting evidence from local studies suggesting that posted paper A&F may be more effective at producing behaviour change than emailed copies of A&F alone.This study seeks to randomise the primary care practices within the pre-arranged QIP, to receive either a paper and emailed A&F report bimonthly for the duration of the study period, or to receive an emailed A&F report alone. The primary outcome of the study would be a comparison of the number of 'low-global warming potential' inhalers prescribed as a percentage of the total prescribed inhalers from each intervention group.

Inclusion Criteria:The study participants will be primary care practitioners, aggregated into the primary care practice in which they work as the unit of study. The principle inclusion criteria will be that the primary care practice meets all inclusion criteria for the regional quality improvement project (QIP) (consents to data sharing, consents to take part in the QIP, is within the boundary for NHS West Yorkshire ICB).Exclusion Criteria:The study participants will be primary care practitioners, aggregated into the primary care practice in which they work as the unit of study. The principle exclusion criteria will be that the primary care practice is not within the boundary for NHS West Yorkshire ICB), or opts out of of the quality improvement project (QIP).