De-implementation of inappropriate inhaled corticosteroid use in patients with COPD in general practice, results of a mixed methods study

Many patients with COPD use inhaled corticosteroids (ICS) without proper indication. We developed a multifaceted tailor-made de-implementation strategy-including a toolbox, communication plan, and training-to reduce inappropriate ICS use in general practice. We evaluated its effectiveness (i.e. decline in percentage of patients with COPD that use ICS) and other outcomes during a 15-month study in Drenthe, the Netherlands. Less patients (-4.7%,95%CI: 2.6-6.7%) used ICS at the end of follow-up and the percentage of ICS-users declined by 8.2% (95%CI: 2.9-13.4%) across the 14 practices that fully participated in the project. ICS user percentages declined significantly moreover time in the fully participation group than in the control group (beta-regression, β = -0.041,SE = 0.011, p < 0.01). While these findings are promising, further research is needed to assess additional penetration and sustainability of the strategy in the region and to explore the applicability of comparable regional ICS de-implementation plans.