Development of an implementation package for Asthma Medication Optimisation in the Emergency Department (AMEND) - an evidence, theory and person-based approach.
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Skene I.
Bloom B.
Bassi J.
De Simoni A.
Pike K.
Griffiths C.
Pfeffer P.
Steed, L.
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2026
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Background: Salbutamol is the most commonly prescribed inhaler for adults discharged from the Emergency Department (ED) with uncontrolled asthma. However newer options, e.g. Maintenance and Reliever Therapy (MART), are now recommended due to growing concerns over risks linked to salbutamol over-prescription. Transitioning to new inhalers requires support for both patients and healthcare professionals (HCP). This paper outlines how we developed an implementation package based on evidence, theory and the person-based approach to support asthma medication optimisation in the ED. Method(s): The purpose of this study was to use person-based intervention development methods in a three phase process: (1) understanding behaviour - collating and synthesising evidence from in-depth interviews with the target population (patients and HCPs); secondary deductive analysis using the theoretical domains framework (TDF) to understand barriers and facilitators to prescribing; developing guiding principles and logic model based on underlying theory (2) identifying behavioural content and implementation options - behaviour change techniques were selected and translated into intervention content (3) intervention materials developed and refined with input of stakeholders. Result(s): We identified modifiable target behaviours for HCPs to support guideline-based care in the ED. These included identifying eligible patients, communicating rationale, providing patients with inhaler and resources, and communicating changes to primary care. Key theoretical domains included knowledge, skills, addressing beliefs about consequences, and targeting professional role perceptions. These domains were targeted through a clinical decision aid and training materials for ED HCP, template discharge summary for primary care, and visual and written materials for patients. Minor refinements were made based on stakeholder feedback (six ED doctor think-aloud interviews; two patient workshops with eight and five participants respectively; and 12 survey responses to final draft of video). Conclusion(s): We developed an intervention grounded in theory, evidence, and stakeholder feedback aimed at promoting and supporting delivery of guideline recommendation. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license.
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