Abstract Rationale Asthma remains the most common chronic respiratory disease in children and a leading cause of emergency department visits, hospitalizations, and school absenteeism. Recent National Heart, Lung, and Blood Institute and Global Initiative for Asthma guidelines strongly recommend Maintenance and Reliever Therapy (MART) for children aged ≥5 years with moderate-to-severe asthma, citing reductions in exacerbation risk and simplified management. However, despite these evidence-based recommendations, MART remains underused in U.S. primary care. Because most pediatric asthma care occurs in these settings, understanding the determinants of MART adoption is essential. This study assessed pediatric primary care clinicians’ familiarity with, comfort using, and barriers to implementing MART within a regional practice-based research network. Methods An 18-item survey was co-developed with clinicians using the Consolidated Framework for Implementation Research (CFIR) to evaluate organizational readiness, implementation climate, and perceived barriers and facilitators to MART adoption. The survey was distributed via RedCap® to physicians and advanced practice providers (APPs) within the Washington University Pediatric and Adolescent Ambulatory Research Consortium (WUPAARC). Responses were summarized using descriptive statistics. Results Of 189 invited clinicians, 52 responded (response rate = 27.5%; 39 physicians, 5 APPs, 8 unspecified). Most practiced in suburban settings (79%), with a median of 12% Medicaid insured patients (IQR: 8-35%). All respondents reported at least some familiarity with MART; however most (n = 32; 62%) had only recently begun prescribing it to some patients. Two thirds (67%) believed that MART would improve asthma outcomes, and 60% reported that it fit their clinical practice. However, clinicians cited numerous barriers: insufficient educational materials for clinicians and families, lack of insurance coverage or FDA reliever indication, and patient or caregiver reluctance to change existing therapy (Table). Only 21% reported access to electronic medical record (EMR) tools to support MART prescribing. Conclusion Pediatric primary care clinicians are increasingly aware of and beginning to implement MART, but uptake is constrained by knowledge gaps, reimbursement barriers, and limited system supports. Findings will inform development of an educational and EMR-based implementation intervention within WUPAARC designed to increase adoption of MART by healthcare providers in this outpatient setting. This abstract is funded by: National Institute of Health (NIH; K23HL171940), and the Doris Duke Charitable Foundation
Peled et al. (Fri,) studied this question.