Implementation and impact of Reliever Reliance Test questionnaire for asthma in primary care patients and healthcare professional perceptions in Greece

Introduction: Over-reliance on short-acting beta-agonists (SABAs) has been identified as a predictor of poor asthma control. We aimed to assess SABA use and over-reliance and their association with asthma control in patients in primary care and the utility and acceptability of the Reliever Reliance Test (RRT), a patient self-administered behaviour-change questionnaire to identify and address SABA over-reliance. Method: A mixed methods study conducted from June 2023 to April 2024. Patients with asthma completed the Asthma Control Test (ACT) assessing asthma control and were evaluated for their use of SABA. Those who reported SABA use completed the RRT questionnaire which offered patients a classification of low, medium or high-risk of over-reliance. A qualitative survey followed with semi-structured interviews to evaluate the feedback obtained from patients and their General Practitioners (GPs) to assess the content, efficacy and applicability of RRT. Results: The study included 145 patients, 40 of whom reported using SABA. Among the 38 participants who completed the RTT, a significant majority (82%) were classified as having a medium-to-high risk of over-reliance on SABAs, while 24% reported overuse of these medications (at least three times per week). The likelihood of poorly controlled asthma based on ACT score increased significantly with greater reliance and more frequent SABA use. The RRT questionnaire demonstrated good reliability (Cronbach's alpha 0.835) and validity, and both patients (n=27) and GPs (n=11) in the qualitative study found it acceptable and helpful in identifying and addressing SABAs over-reliance. GPs also expressed their intention to incorporate the questionnaire into clinical practice, despite time constraints. Discussion: Our findings suggest that RRT has potential utility in identifying and addressing SABA over-reliance, prompting dialogue between patients and GPs to achieve optimal asthma outcomes. Further research is necessary to explore the extent to which the RRT will modify help-seeking behavior and medication use. Funding: IPCRG funded this project.