Abstract：
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.
To gain an in-depth understanding of the facilitators and barriers to prescribing reliever ICS-formoterol inhalers and SMART in the United States.
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.
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.
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.
To gain an in-depth understanding of the facilitators and barriers to prescribing reliever ICS-formoterol inhalers and SMART in the United States.
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.
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.
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.
摘要：
背景：全球哮喘倡议（GINA）和国家哮喘教育和预防计划（NAEPP）最近提出了关于哮喘吸入器管理的范式转变建议。GINA现在建议在所有管理步骤中，联合吸入皮质类固醇（ICS）-福莫特罗吸入器代替短效β-激动剂作为首选的缓解疗法。虽然最新的NAEPP指南没有审查缓解剂ICS-福莫特罗在轻度哮喘中的使用，他们同样在哮喘管理的第3-4步中推荐单一维持和缓解治疗(SMART).尽管有这些建议,许多临床医生,特别是在美国(US),没有开出新的吸入器范例.这种实施差距的临床医生层面的原因在很大程度上仍未被探索。
目标：在传播和实施科学框架的指导下，我们对临床医生进行了深入访谈，和障碍，在轻度哮喘和SMART内开出缓解剂ICS-福莫特罗。
方法：社区和学术初级保健提供者，肺病学家,和报告定期照顾成人哮喘的变态反应学家接受了采访。采访被记录下来，转录，定性编码，并使用实施研究综合框架(CFIR)进行分析。面试一直持续到主题饱和。
结果：在20位受访临床医生中，只有6名临床医生描述了将ICS-福莫特罗吸入器作为缓解剂吸入器(单独或在SMART内)定期处方.新吸入器方法的重大障碍包括缺乏食品和药物管理局对ICS-福莫特罗作为缓解疗法的标签的担忧，缺乏对患者处方集首选ICS长效β-激动剂选择的认识，组合式吸入器的高成本，和时间限制。使用新吸入器方法的促进者包括临床医生认为最新吸入器建议更简单，更符合真实世界的患者行为，管理战略的潜在变化将为共同决策提供宝贵的机会。
结论：虽然哮喘有新的指南，许多临床医生描述了使用它们的重大障碍，包括医学法律问题，药物配方混乱，和高昂的药物成本。尽管如此，大多数临床医生认为,最新的吸入器方法对患者来说更直观,并为以患者为中心的合作和护理提供了机会.利益相关者可能会发现这些结果在未来尝试中有用，以增加近期哮喘建议的实际采用。
目标：在传播和实施科学框架的指导下，我们对临床医生进行了深入访谈，和障碍，在轻度哮喘和SMART内开出缓解剂ICS-福莫特罗。
方法：社区和学术初级保健提供者，肺病学家,和报告定期照顾成人哮喘的变态反应学家接受了采访。采访被记录下来，转录，定性编码，并使用实施研究综合框架(CFIR)进行分析。面试一直持续到主题饱和。
结果：在20位受访临床医生中，只有6名临床医生描述了将ICS-福莫特罗吸入器作为缓解剂吸入器(单独或在SMART内)定期处方.新吸入器方法的重大障碍包括缺乏食品和药物管理局对ICS-福莫特罗作为缓解疗法的标签的担忧，缺乏对患者处方集首选ICS长效β-激动剂选择的认识，组合式吸入器的高成本，和时间限制。使用新吸入器方法的促进者包括临床医生认为最新吸入器建议更简单，更符合真实世界的患者行为，管理战略的潜在变化将为共同决策提供宝贵的机会。
结论：虽然哮喘有新的指南，许多临床医生描述了使用它们的重大障碍，包括医学法律问题，药物配方混乱，和高昂的药物成本。尽管如此，大多数临床医生认为,最新的吸入器方法对患者来说更直观,并为以患者为中心的合作和护理提供了机会.利益相关者可能会发现这些结果在未来尝试中有用，以增加近期哮喘建议的实际采用。
