Abstract

Background
Aligning clinical practice with evidence-based recommendations is slow and complex, often requiring multiple strategies. It can take up to 17 years for research to translate into practice, with implementation rates as low as 8–15%. Ongoing clinical inertia negatively impacts patient outcomes.

An evidence-based emancipatory practice development (EBEPD) framework was implemented to promote ‘embodied integrated knowing’ and empower clinicians to improve asthma management in a practice where salbutamol remained overprescribed two years after NG245 publication. National drivers, including the Greener NHS agenda and the MHRA 2025 Drug Safety Update, reinforced the urgency.

Aims
Reduce risks associated with excessive salbutamol (SABA) prescribing by embedding the NG245 AIR/MART pathway into routine primary care practice

Method
Evidence-based co-design (EBCD) principles and anonymised Microsoft Forms questionnaires were used to:

-Assess clinicians' current perceptions of asthma care quality at the practice
-Explore current clinical practice
-Identify barriers and enablers to NG245 implementation

The World Café model facilitated discussion around workload pressures and implementation challenges.

Results
Around 50% of respondents reported key barriers:

-Limited guideline awareness
-Time constraints
-Lack of confidence
-Established prescribing habits

Confidence gaps were identified:

-5/13 prescribers lacked confidence managing suspected asthma
-6/13 lacked confidence applying updated guidance

Key enablers included:

-EMIS prescribing prompts
-A4 guideline summaries
-Educational sessions
Rapid access to peer support

Conclusion
Improving asthma care requires more than guideline dissemination; it demands culturally embedded, practice-based change. EBEPD and co-design approaches identified key barriers alongside practical, clinician-led solutions, including structured prompts, targeted education, and peer support, which can enable sustained uptake of AIR/MART. Embedding these strategies into routine practice may reduce SABA overuse, enhance patient safety, and align care with local and national guidelines.

Positive deviance, as an asset-based approach, recognises that effective solutions already exist within teams. When combined with EBEPD in time-pressured environments, it enables clinical champions to drive innovation, overcome resistance, and sustain meaningful change.