Abstract Rationale International asthma guidelines recommend the use of combination inhaled corticosteroid (ICS)-formoterol inhalers as both maintenance and reliever therapy (MART) for adults with moderate-to-severe asthma, as this approach reduces the risk of exacerbations. An academic internal medicine residency program implemented an educational initiative consisting of didactic sessions and an electronic medical record (EMR)-based order set beginning in 2022 to improve MART prescribing. To evaluate the impact of this initiative, we assessed the MART prescribing and short-acting beta-agonist (SABA) de-prescribing rates across pulmonology, allergy, attending primary care, and resident primary care clinics within a large multisite academic medical center. Methods Our team previously developed and validated an algorithm that leverages large language models to accurately identify MART prescriptions within the EMR. In this study, we applied this algorithm to identify all clinician-prescribed MART cases among adults (≥18 years old) with asthma, as defined by International Classification of Diseases, 10th Revision (ICD-10) codes, between January 2020 and July 2025. We also evaluated how often SABAs were removed from patients’ active medication lists when MART was prescribed. Trends in MART prescribing across clinics were analyzed using an interrupted time-series model with a cut point of January 1, 2022, to assess the impact of the educational initiative. Results We analyzed 59,692 encounters for patients with moderate-to-severe asthma who received care at one of 185 allergy, primary care, and pulmonology clinics across our healthcare system. Rates of MART prescribing and SABA de-prescribing increased over the study period. In the resident primary care clinic, the rate of MART prescribing increased from 1.0% (95% confidence interval CI 0.0-1.2%) in 2020 to 23.9% (95% CI 20.4-27.3%) in 2025 (Figure). The rate of SABA de-prescribing when MART was prescribed increased from 0.0% (95% CI 0.0-0.0%) to 91.5% (95% CI 87.0-96.1%) when MART was prescribed in the resident clinic over the same period. Overall, there was a significant change in the trend of MART prescribing following the educational intervention, as evidence by a 5.8% (95% CI 2.7-14.3%) annual increase in asthma encounters with MART prescriptions. Conclusions MART prescribing, and SABA de-prescribing when MART is prescribed, have both increased over time, yet MART remains markedly underutilized. In our resident primary care clinic, educational and EMR-based interventions substantially improved adoption of guideline-recommended MART into routine clinical practice. Further evaluation is needed to determine whether similar interventions can be effectively implemented and sustained across other clinics to enhance delivery of guideline-directed asthma therapy. This abstract is funded by: This research was supported in part the National Institute of Health (NIH; K23HL171940), and the Doris Duke Charitable Foundation. The views do not necessarily reflect those of the NIH, or Doris Duke Charitable Foundation.
Quinn et al. (Fri,) studied this question.