Development of an implementation package for Asthma Medication Optimisation in the Emergency Department (AMEND) - an evidence, theory and person-based approach

BackgroundSalbutamol 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. MethodsThe 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. ResultsWe 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). ConclusionWe developed an intervention grounded in theory, evidence, and stakeholder feedback aimed at promoting and supporting delivery of guideline recommendation. KEY MESSAGESO_ST_ABSWhat is already knownC_ST_ABSED visits represent teachable moments where patients may be receptive to optimising asthma medication, yet guideline-concordant prescribing is often limited in fast-paced settings. What this study addsThis study describes AMEND, a behaviourally informed implementation package including a clinical decision aid, HCP training, and patient-facing materials, designed to support initiation of Maintenance and Reliever Therapy (MART) at discharge. Using stakeholder-informed, iterative development, the package was feasible to integrate into routine ED workflows. How this study might affect research, practice or policyFindings highlight how theory-driven interventions can translate guidelines into practice, improve adherence, and potentially reduce repeat ED attendances.