Abstract Rationale Despite the introduction of Single Maintenance and Reliever Therapy (SMART) in the National Heart, Lung, and Blood Institute (NHLBI) 2020 Focused Asthma Updates, SMART has not been widely implemented. Through a quality improvement (QI) initiative we aim to increase the proportion of eligible patients prescribed SMART with budesonide-formoterol by 50%. Methods This QI project was conducted in a community-based asthma clinic in a large metropolitan city. Baseline metrics for the 6-months prior to intervention (July - December 2024) were established with chart review of patients prescribed budesonide-formoterol. A provider focus group, identified provider knowledge regarding SMART and need for prior authorization (PA) as barriers towards implementation. Therefore, the following interventions were developed: (1) provider educational session, (2) provider reference sheet, (3) SMART indicator on electronic asthma action plan, (4) EMR auto-text support for preauthorizations, (5) electronic prescription templates, (6) patient information sheets, (7) school nurse information sheets, and (8) patient facing educational video. Patient centered interventions were provided in English and Spanish. Interventions were implemented step-wise, with monthly review of SMART prescriptions. Primary outcome included the proportion of eligible patients prescribed SMART. Results Baseline data (average monthly rate July-December 2024) demonstrated that 32% of monthly budesonide-formoterol prescriptions were written as SMART. Interventions 1-7 have been implemented, and 8 is in process. The implementation of patient information sheets and school nurse information sheets, occurring in May and June 2025 respectively, resulted in the largest increase in SMART prescription rates. In July 2025 there was a 56% increase compared with baseline, and a 100% increase compared to July 2024. This further increased in August 2025, the highest SMART prescription rate observed throughout the study period, representing a 50% increase compared to August 2024, and a 134% increase compared to baseline monthly average. Conclusion The interventions with the greatest impact were focused on self-directed education for families and caretakers, likely due to reduction in time spent by providers on education during the office visit. At the end of 8 months, SMART prescription rates more than doubled, demonstrating a change in prescribing practices powered by clinical support tools and time-saving educational resources. We anticipate that the final intervention (patient education video) has potential to further increase and sustain SMART prescribing practices. These efforts will improve access to guideline-based asthma therapy and ultimately improve asthma outcomes. This abstract is funded by: None
Vera et al. (2026) studied this question.