Abstract Rationale Anti-inflammatory reliever (AIR) therapy is now the preferred inhaler management strategy for asthma, providing both symptom relief and anti-inflammatory benefits with reliever inhaler use. Two AIR approaches - MART (Maintenance and Reliever Therapy) and PARTICS (Patient Activated Reliever Triggered Inhaled Corticosteroids) have been shown to reduce the risk of asthma exacerbations. MART uses a single inhaler combining an ICS and formoterol for both daily maintenance and as-needed symptom relief. In contrast, PARTICS involves a maintenance inhaler containing an inhaled corticosteroid (ICS), along with separate reliever inhalers consisting of a short-acting beta-agonist (SABA) taken concurrently with an ICS. The PCORI-funded iCARE trial (NCT06596512) will compare the real-world effectiveness of MART and PARTICS through an upcoming multisite pragmatic clinical trial. A preceding feasibility phase, reported here, identified key barriers and facilitators to implementation and patient use of both approaches. Methods We conducted focus groups and individual interviews with study physicians, pharmacists, coordinators, and participants from five iCARE vanguard sites to explore their experiences with MART and PARTICS implementation. A subset of participants completed follow-up interviews at 1- and/or 3 months post-enrollment. Interviews were audio-recorded, professionally transcribed, and analyzed using an iterative, inductive approach informed by immersion crystallization methods. Key domains of inquiry included: training, workflow integration, prescription processes, communication, and medication use. Results Pharmacists (n = 5) reported that pre-existing tools, electronic templates, and institutional resources facilitated efficient prescribing. The use of internal pharmacies streamlined workflows and supported problem-solving during the prescription process. Mock prescriptions and video-based modules were effective training tools for study coordinators (n = 4). Participants (n = 12) reported that coordinated, team-based care, and responsive communication improved their asthma management. Barriers to MART and PARTICS implementation noted by study physicians and pharmacists included limited training on prior authorizations, which delayed medication approval during the prescription process (Table). For pharmacists, coordinators, and participants, uncertainty regarding out-of-pocket costs and variability in insurance coverage created barriers for both MART and PARTICS prescribing. Pharmacists noted that MART often required additional justification for insurance coverage, and participants reported higher out-of-pocket costs with PARTICS. Conclusion Establishing clear workflows, standardized training, and defined team roles is helpful for successful implementation of MART and PARTICS. Addressing insurance authorization and cost barriers could reduce prescribing challenges and enhance the feasibility of these inhaler strategies. This study helps close knowledge gaps regarding barriers and facilitators to MART and PARTICS implementation and highlights several avenues for enhancing patient-centered asthma care. This abstract is funded by: PCORI
Iyer et al. (Fri,) studied this question.