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Clinician Views on Inhaler Substitution in the Veterans Health Administration.

Alexandra M Peirce1, Cainnear K Hogan2, Julien B Weinstein3

  • 1Department of Internal Medicine, University of Michigan, Ann Arbor, MI.

Chest
|November 28, 2025
PubMed
Summary

Veterans Health Administration clinicians reported negative perceptions of a nationwide inhaler formulary change, citing concerns about patient education and outcomes. Effective communication and specialty engagement are crucial for future transitions.

Keywords:
COPDVeterans Health Administrationclinician surveyformulary changeinhaler switch

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Area of Science:

  • Health Services Research
  • Pulmonary Medicine
  • Pharmacy Practice

Background:

  • The Veterans Health Administration (VHA) enacted a significant inhaler formulary change in 2021, impacting over 260,000 patients with COPD and asthma.
  • Understanding clinician perspectives on this transition is vital for assessing its impact and informing future policy.

Purpose of the Study:

  • To investigate Veterans Health Administration (VHA) clinician perspectives on the formulary change from budesonide-formoterol metered-dose inhaler (MDI) to fluticasone-salmeterol dry-powder inhaler (DPI).

Main Methods:

  • A cross-sectional survey was conducted among VHA pulmonologists, pharmacists, and primary care providers from September to October 2024.
  • The survey assessed clinician experiences, veteran notification, education effectiveness, and overall sentiment regarding the inhaler formulary change.

Main Results:

  • Over half of respondents (54.4%) believed veterans were informed, but only 24.7% found the education effective.
  • A significant majority (75.5%) of open-ended comments expressed negative sentiment, highlighting concerns about inhaler tolerance, patient outcomes, and provider workload.
  • Pulmonologists showed lower awareness of veteran communication methods compared to pharmacists and primary care providers.

Conclusions:

  • VHA clinicians predominantly held negative views on the 2021 inhaler formulary change.
  • The findings emphasize the critical need for improved clinician communication, robust patient education, and active engagement of medical specialties during formulary transitions.