Barriers to Implementing SMART for Asthma in Pediatric Primary Care.
OBJECTIVES: To characterize awareness, use, and perceived barriers to implementing single maintenance and reliever therapy (SMART) in primary care for children aged 5 years or older, hypothesizing high clinician awareness but limited use due to multilevel clinician-, system-, and caregiver barriers....
| Published in: | Pediatrics Vol. 158; no. 2; pp. 1 - 2 |
|---|---|
| Main Authors: | , , , , , , , , , |
| Format: | pictorial research tables/charts Journal Article |
| Published: |
American Academy of Pediatrics
Aug2026
|
| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=195830999&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 195830999 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00314005 PDT jtl: Pediatrics issn: 00314005 maglogo: N pubinfo: dt: Aug2026 vid: 158 iid: 2 pid: 1659 pub: American Academy of Pediatrics place: Elk Grove Village, Illinois artinfo: ui: 195830999 195830999 195830999 10.1542/peds.2026-076324 195830999 ppf: 1 ppct: 1 formats: tig: atl: Barriers to Implementing SMART for Asthma in Pediatric Primary Care. aug: au: Peled, Julia Dodd, Sherry Graham, Sharon Wang, Ruoyun Rook, Shannon Plax, Katie James, Aimee S. Harris, Kelly King, Allison A. Krings, James G. affil: Division of Allergy and Pulmonology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri sug: subj: Asthma Drug Therapy Pediatric Care Primary Health Care Bronchodilator Agents Therapeutic Use Program Implementation Human Multimethod Studies Prescribing Patterns Semi-Structured Interview Purposive Sample Attitude of Health Personnel Workflow Insurance Coverage Caregiver Burden Audit Feedback Implementation Science Adrenergic beta-Agonists Therapeutic Use Nebulizers and Vaporizers Caregiver Attitudes Child Child: 6-12 years ab: OBJECTIVES: To characterize awareness, use, and perceived barriers to implementing single maintenance and reliever therapy (SMART) in primary care for children aged 5 years or older, hypothesizing high clinician awareness but limited use due to multilevel clinician-, system-, and caregiver barriers. METHODS: We conducted a sequential explanatory mixed-methods study among pediatric primary care clinicians within a practice-based research network. Clinicians completed a survey assessing SMART awareness, prescribing practices, and perceived barriers, guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Semistructured interviews were conducted with purposively sampled clinicians to explore factors influencing SMART implementation. Qualitative data were analyzed using an inductive-deductive approach and mapped to CFIR 2.0 constructs. RESULTS: Fifty-two clinicians (27.5%) completed the survey, and 24 completed interviews. Awareness of SMART was universal, but use remained limited among eligible pediatric patients, particularly younger children. Clinicians viewed SMART as effective and guideline-concordant but described multilevel barriers to routine implementation. Qualitative analysis identified 3 themes: (1) SMART is clinically advantageous but challenging to operationalize; (2) system-level and workflow barriers, including insurance coverage and prior authorization requirements, constrain adoption; and (3) caregiver resistance impedes deimplementation of short-acting β-agonists. Absence of SMART-specific asthma action plans emerged as a key barrier across care settings. CONCLUSION: Pediatric primary care clinicians endorse SMART therapy but face persistent clinician-, system-, and caregiver-level barriers to its implementation and to the deimplementation of short-acting β-agonists. Implementation strategies incorporating practice facilitation, audit and feedback, and electronic health record–generated SMART-specific asthma action plans may support more consistent uptake of pediatric guideline–concordant asthma care. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|