NHS tackles potential over-prescription of short course steroid

Prednisolone is a short course steroid, which can be crucial in treating respiratory illnesses. However recent studies have shown that prescribing too many short course steroids could cause some adverse health conditions. This includes diabetes, cardiovascular illnesses, mental health disorders, musculoskeletal conditions such as osteoporosis and fractures, and many others.

In 2020 alone more than 35,500 people were prescribed over three grams of prednisolone, considered a high dose. Altogether over a million people in England took the drug.

NHSBSA is collaborating with Guy’s and St Thomas’ NHS Foundation Trust and the Oxford Academic Health Science Network (Oxford AHSN) which is leading the national Accelerated Access Collaborative / AHSN Network severe asthma and asthma biologics programme.

Darren Curry, Chief Digital and Data Officer at NHS Business Services Authority said: “I’m proud to say that at NHSBSA a lot of the work we do is around patient safety and to provide the data and access to data which helps to improve patients’ lives. We’ve worked with Oxford AHSN and Guys and Thomas Hospital for the past eight months, collaborating and sharing to bring all of our skills together to help make a difference.”  

Seema Gadhia, Pharmacy Lead at Oxford AHSN said: “Being able to identify people on high cumulative doses of oral corticosteroids, and offer alternative treatment management, has the potential to significantly improve outcomes and reduce the risk of steroid related side effects.”

Grainne d’Ancona, consultant pharmacist and clinical champion for the programme said: “For the moment, oral corticosteroids still have a role in managing airways disease. However, they must not be mistaken for an innocuous and inevitable consequence of having asthma or COPD. Our awareness of the problems associated with them and the availability of effective alternative strategies to achieve disease control, including optimised adherence to preventer inhalers and newer biologic therapies for appropriate patients, mean we can and should reduce patient’s need for them. Facilitating early identification of those most in need of a review is a crucial step on this path.”

The new metric looks at patients in England who have been prescribed prednisolone tablets, as well as an asthma/COPD medication in the last 12 months. It calculates the total cumulative dose, in milligrams, for the whole period. This will help clinicians to identify everyone at risk, and to prioritise those most at risk for review. At-risk patients may be suited to alternative therapies or clinical strategies.

This method also minimises the chance of including patients who are taking prednisolone for non-respiratory conditions, which can include Crohn’s disease and rheumatoid arthritis.