A36-23 Asthma Care in Maryland: A Qualitative Study of Patient Perceived Barriers

Rationale

High rates of poor asthma control have resulted in over 8 million annual exacerbations. With the introduction of biologic agents, even patients with severe persistent asthma are often able to avoid emergency department (ED) use and hospitalization with appropriate preventive treatment. However, access to and utilization of guideline-recommended biologic agents has remained suboptimal. This interview-based study was designed to evaluate barriers hindering access to preventive treatments from the patient perspective.

Methods

Using electronic health records of a large state-wide healthcare system serving a diverse population, we identified adults with asthma who experienced at least one hospital admission or ED visit in 2025 for acute asthma exacerbation while being treated with a medium or high dose inhaled corticosteroid and at least one other controller therapy. Eligible individuals were contacted to offer participation in a semi-structured interview focused on patient perceived care access barriers. We aimed for 20-25 participants, guided by thematic saturation. All interviews were transcribed and analyzed using NVivo software.

Results

Twenty-one participants were interviewed, reporting barriers to asthma care across five thematic areas: cost, care availability, logistical barriers, medical literacy and preferences, and desire for rapidly effective treatment (Table 1). Participants reported high out of pocket costs resulting in skipping refills or routine clinical visits, with some participants reporting seeking care in ED or hospital settings due to unaffordable costs encountered through traditional outpatient care routes. Participants also reported not bringing symptoms to outpatient care providers’ attention due to their chronicity and the perception that these symptoms were “normal” over time.When discussing outpatient specialist access, participants highlighted barriers including long wait times, travel distance, referral restrictions, and clinic hours resulting in conflicts limiting scheduling opportunities. Many participants also reported feeling more comfortable with seeking care through inpatient or emergency care facilitates due to perceived faster response time of providers and more immediate effectiveness of treatments provided. Finally, participants reported limited understanding of treatment goals, anticipated disease and treatment course, and side effects associated with rescue treatments such as systemic steroids.

Conclusions

This qualitative study provides rich data on barriers to care experienced by patients with poorly controlled asthma. Our results highlight novel potential areas for intervention including target areas to clarify communication of symptom control goals and treatment expectations. Future research should explore the most effective ways to address these care barriers with the goal of improving access to preventative therapies among patients living with asthma.

This abstract is funded by: University of Maryland Baltimore, Institute for Clinical & Translational Research (ICTR) [grant number UM1TR004926-02]