Embedding MART Into Routine Asthma Care: A Primary Care Prescribing Optimisation Project

South Coast Medical Group

Project summary

This project addressed the persistent problem of poorly controlled asthma and unsafe, SABA-heavy prescribing within a Primary Care Network (PCN). Despite MART being recommended by NICE NG80 and BTS/SIGN, uptake in primary care has remained low due to inconsistent prescribing practices, limited clinician confidence, and poor patient understanding. The aim was to improve asthma control, reduce exacerbations, and optimise medicines use by embedding MART as routine practice rather than a specialist intervention.

The project was delivered through a structured prescribing optimisation programme led by respiratory nurse leaders, working collaboratively with GPs, practice nurses and pharmacists. Patients with uncontrolled asthma were identified using prescribing searches and asthma registers, focusing on those with excess SABA use or frequent exacerbations. Clinicians received targeted education aligned to real-time prescribing data and ICS dashboards, improving confidence in initiating and titrating MART. Eligible patients were actively reviewed, switched from high-risk regimens to MART where appropriate, and supported through shared decision-making, inhaler technique checks and personalised asthma action plans.

Impact was evaluated using prescribing, clinical and patient-reported outcome measures. Prescribing data demonstrated a significant reduction in SABA inhaler use and a shift towards evidence-based ICS-formoterol prescribing aligned with national guidance. There was a reduction in prescribing items associated with exacerbation management, including oral corticosteroids and emergency antibiotics. Patient outcomes improved, with higher Asthma Control Test (ACT) scores, fewer reported nocturnal symptoms, and increased confidence in self-management. Patient feedback highlighted improved understanding of asthma control and reduced reliance on reliever inhalers.

System-level outcomes showed fewer asthma-related A&E attendances and hospital admissions, particularly among high-risk patients. From a value perspective, the project required minimal investment beyond staff time for education and reviews. This was offset by reduced emergency prescribing, lower acute care utilisation, and improved prescribing efficiency, demonstrating a clear return on investment through prevention rather than crisis management.

The project strongly aligns with Medicines Optimisation and Royal Pharmaceutical Society principles, prioritising patient safety, evidence-based prescribing, shared decision-making and multidisciplinary working. By embedding MART into routine asthma reviews using existing data and workflows, the approach is highly replicable across PCNs and ICSs. Overall, the project demonstrates how prescribing optimisation can deliver measurable improvements in patient outcomes, system sustainability and value for money