200 - SMARTen Up: A QI Initiative to Improve Outpatient Asthma Prescribing at Albany Medical Center.

Poster Number: 200
Publication Number: 200.391

Background: In 2019, the Global Initiative for Asthma (GINA) updated guidelines to include Single Maintenance and Reliever Therapy (SMART). SMART has been shown to improve asthma symptom control and reduce asthma exacerbations. We hypothesized that poor institutional knowledge regarding SMART persists at our institution and that conventional asthma therapy remains the predominant therapy for outpatient asthma management.

Objective: To increase the outpatient rate of SMART prescription practices at Albany Medical Center.

Design/Methods: 1. We evaluated baseline pediatric healthcare provider (HCP; resident/attending physicians) knowledge via a Qualtrics survey; 2. We performed a tailored educational initiative to improve provider awareness of the 2019 GINA guidelines to optimize SMART knowledge, and 3. We conducted a chart review and post-intervention provider survey to elucidate if prescribing practices in General Pediatrics outpatient clinic differed between September-December 2022 and September-December 2023.

Results: Pre-intervention survey data revealed that of those respondents regularly prescribing for asthma, only 3/8 had received formal education regarding SMART.

Our educational initiative included two 30-minute resident didactic lectures in October and November 2022; the creation of SMART quick reference posters distributed in outpatient and inpatient settings; and a presentation at Pediatric Grand Rounds (May 2023).

Subsequent chart review demonstrated that SMART and conventional asthma therapy were prescribed at similar rates between September-December in 2022 (Conventional=298; SMART=49) and September-October 2023 (Conventional=105; SMART=16) with p-value 0.93.

A post-intervention survey was released in October 2023; of 12 respondents, six (50%) listed knowledge barriers and three (25%) listed insurance barriers as the most significant barrier to prescribing SMART. There was no significant difference in the rate of SMART versus conventional therapy in public versus private insurance (Medicaid versus non-Medicaid) in 2022 (p=0.194) or 2023 (p=1.00).

Conclusion(s): At our institution, conventional asthma therapy remains more commonly prescribed than SMART. Insufficient HCP knowledge remains a barrier to SMART prescription practices at AMC. Insurance barriers are also perceived to be contributing to poor prescription practices despite equivocal insurance coverage. Our next steps after completion of the post-intervention survey include continued education within our pediatric community, including a regional presentation to pediatric practices within greater Albany.