TY - JOUR
T1 - Beginning to Address an Implementation Gap in Asthma
T2 - Clinicians’ Views of Prescribing Reliever Budesonide-Formoterol Inhalers and SMART in the United States
AU - Krings, James G.
AU - Sekhar, Tejas C.
AU - Chen, Vanessa
AU - Blake, Kathryn V.
AU - Sumino, Kaharu
AU - James, Aimee S.
AU - Clover, Amber K.
AU - Lenze, Eric J.
AU - Brownson, Ross C.
AU - Castro, Mario
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2023/9
Y1 - 2023/9
N2 - Background: The Global Initiative for Asthma and National Asthma Education and Prevention Program recently made paradigm-shifting recommendations regarding inhaler management in asthma. The Global Initiative for Asthma now recommends that combination inhaled corticosteroid (ICS)-formoterol inhalers replace short-acting β-agonists as the preferred reliever therapy at all steps of asthma management. Although the most recent guidelines of the National Asthma Education and Prevention Program did not review reliever ICS-formoterol usage in mild asthma, they similarly recommended single maintenance and reliever therapy (SMART) at steps 3 and 4 of asthma management. Despite these recommendations, many clinicians—particularly in the United States—are not prescribing new inhaler paradigms. Clinician-level reasons for this implementation gap remain largely unexplored. Objective: To gain an in-depth understanding of the facilitators and barriers to prescribing reliever ICS-formoterol inhalers and SMART in the United States. Methods: Community and academic primary care providers, pulmonologists, and allergists who reported regularly caring for adults with asthma were interviewed. Interviews were recorded, transcribed, qualitatively coded, and analyzed using the Consolidated Framework for Implementation Research. Interviews were continued until theme saturation. Results: Among 20 interviewed clinicians, only 6 clinicians described regularly prescribing ICS-formoterol inhalers as a reliever inhaler (either alone or within SMART). Significant barriers to new inhaler approaches included concerns surrounding a lack of Food and Drug Administration labeling for ICS-formoterol as a reliever therapy, a lack of awareness regarding a patient's formulary-preferred ICS–long-acting β-agonist choices, the high cost of combination inhalers, and time constraints. Facilitators to using new inhaler approaches included clinicians’ beliefs that the latest inhaler recommendations are simpler and more congruent with real-world patients’ behavior, and that a potential change in management strategy would offer a valuable opportunity for shared decision making. Conclusions: Although new guidelines exist in asthma, many clinicians described significant barriers to using them including medicolegal issues, pharmaceutical formulary confusion, and high drug costs. Nonetheless, most clinicians believed that the latest inhaler approaches would be more intuitive for their patients and would offer an opportunity for patient-centered collaboration and care. Stakeholders may find these results useful in future attempts to increase the real-world adoption of recent asthma recommendations.
AB - Background: The Global Initiative for Asthma and National Asthma Education and Prevention Program recently made paradigm-shifting recommendations regarding inhaler management in asthma. The Global Initiative for Asthma now recommends that combination inhaled corticosteroid (ICS)-formoterol inhalers replace short-acting β-agonists as the preferred reliever therapy at all steps of asthma management. Although the most recent guidelines of the National Asthma Education and Prevention Program did not review reliever ICS-formoterol usage in mild asthma, they similarly recommended single maintenance and reliever therapy (SMART) at steps 3 and 4 of asthma management. Despite these recommendations, many clinicians—particularly in the United States—are not prescribing new inhaler paradigms. Clinician-level reasons for this implementation gap remain largely unexplored. Objective: To gain an in-depth understanding of the facilitators and barriers to prescribing reliever ICS-formoterol inhalers and SMART in the United States. Methods: Community and academic primary care providers, pulmonologists, and allergists who reported regularly caring for adults with asthma were interviewed. Interviews were recorded, transcribed, qualitatively coded, and analyzed using the Consolidated Framework for Implementation Research. Interviews were continued until theme saturation. Results: Among 20 interviewed clinicians, only 6 clinicians described regularly prescribing ICS-formoterol inhalers as a reliever inhaler (either alone or within SMART). Significant barriers to new inhaler approaches included concerns surrounding a lack of Food and Drug Administration labeling for ICS-formoterol as a reliever therapy, a lack of awareness regarding a patient's formulary-preferred ICS–long-acting β-agonist choices, the high cost of combination inhalers, and time constraints. Facilitators to using new inhaler approaches included clinicians’ beliefs that the latest inhaler recommendations are simpler and more congruent with real-world patients’ behavior, and that a potential change in management strategy would offer a valuable opportunity for shared decision making. Conclusions: Although new guidelines exist in asthma, many clinicians described significant barriers to using them including medicolegal issues, pharmaceutical formulary confusion, and high drug costs. Nonetheless, most clinicians believed that the latest inhaler approaches would be more intuitive for their patients and would offer an opportunity for patient-centered collaboration and care. Stakeholders may find these results useful in future attempts to increase the real-world adoption of recent asthma recommendations.
KW - Asthma
KW - Asthma guidelines
KW - Dissemination and implementation science
KW - Inhalers
KW - Qualitative study
UR - http://www.scopus.com/inward/record.url?scp=85166547398&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2023.05.023
DO - 10.1016/j.jaip.2023.05.023
M3 - Article
C2 - 37245736
AN - SCOPUS:85166547398
SN - 2213-2198
VL - 11
SP - 2767
EP - 2777
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 9
ER -