A high prevalence of suboptimal asthma control is attributable to known evidence-practice gaps. We developed a computerised clinical decision support system (the Electronic Asthma Management System – eAMS) to address major care gaps and sought to measure its impact on care in adults with asthma.
This was a 2-year interrupted time series study of usual care (year 1) versus eAMS (year 2) at 3 Canadian primary care sites. We included asthma patients aged ≥16 years receiving an asthma medication within the last 12 months. The eAMS consisted of a touch tablet patient questionnaire completed in the waiting room, with real-time data processing producing electronic medical record-integrated clinician decision support.
Action plan delivery (primary outcome) improved from 0/412 (0%) to 79/443 (17.8%) eligible patients [absolute increase 0.18 (0.14,0.22)]. Time series analysis indicated a 30.5% increase in physician visits with action plan delivery with the intervention (p<0.0001). Assessment of asthma control level increased from 173/3497 (4.9%) to 849/3062 (27.7%) eligible visits [adjusted OR 8.62 (5.14, 12.45)]. Clinicians escalated controller therapy in 108/3422 (3.2%) baseline visits versus126/3240 (3.9%) intervention visits (p=0.12). At baseline, a short-acting beta-agonist alone was added in 62 visits and a controller added in 54 visits; with the intervention, this occurred in 33 and 229 visits, respectively (p<0.001).
The eAMS improved asthma quality of care in real-world primary care settings. Strategies to further increase clinician uptake and a randomised controlled trial to assess impact on patient outcomes are now required.