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Eur Respir J. 2019 Apr 25;53(4). pii: 1802241. doi: 10.1183/13993003.02241-2018. Print 2019 Apr.

The Electronic Asthma Management System (eAMS) improves primary care asthma management.

Author information

1
Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada guptas@smh.ca.
2
Division of Respirology, Dept of Medicine, University of Toronto, Toronto, ON, Canada.
3
Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
4
Dept of Family Medicine, McMaster University, Hamilton, ON, Canada.
5
Health Quality Innovation Collaborative, Brampton, ON, Canada.
6
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Universite Laval, Québec, QC, Canada.
7
Family Physician Airways Group of Canada, Edmonton, AB, Canada.
8
Respiratory Medicine Special Interest Focus Group, College of Family Physicians of Canada, Mississauga, ON, Canada.
9
Applied Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
10
Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
11
Li Ka Shing Centre for Healthcare Analytics Research and Training (LKS-CHART), Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
12
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.

Abstract

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 three 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 zero out of 412 (0%) to 79 out of 443 (17.8%) eligible patients (absolute increase 0.18 (95% CI 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 out of 3497 (4.9%) to 849 out of 3062 (27.7%) eligible visits (adjusted OR 8.62 (95% CI 5.14-12.45)). Clinicians escalated controller therapy in 108 out of 3422 (3.2%) baseline visits versus 126 out of 3240 (3.9%) intervention visits (p=0.12). At baseline, a short-acting β-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.

Conflict of interest statement

Conflict of interest: S. Gupta has nothing to disclose. Conflict of interest: C. Price has nothing to disclose. Conflict of interest: G. Agarwal has nothing to disclose. Conflict of interest: D. Chan has nothing to disclose. Conflict of interest: S. Goel has nothing to disclose. Conflict of interest: L-P. Boulet reports grants from AstraZeneca, Boston Scientific, GlaxoSmithKline, Hoffman La Roche, Novartis, Ono Pharma, Sanofi and Takeda, support for research projects from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck and Takeda, consultancy and advisory board work for AstraZeneca, Novartis and Methapharm, grants for production of educational materials from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck Frosst and Novartis, conference fees from AstraZeneca, GlaxoSmithKline, Merck and Novartis, support for participation in conferences and meetings from Novartis and Takeda; is past president and member of the Canadian Thoracic Society Respiratory Guidelines Committee; chair of the board of directors of the Global Initiative for Asthma (GINA); chair of GINA guidelines dissemination and implementation committee; Laval University chair on knowledge transfer, prevention and education in respiratory and cardiovascular health; member of scientific committees for the American College of Chest Physicians, American Thoracic Society, European Respiratory Society and the World Allergy Organization; First Vice-President of the global asthma organisation “Interasma”. Conflict of interest: A.G. Kaplan has nothing to disclose. Conflict of interest: G. Lebovic has nothing to disclose. Conflict of interest: M. Mamdani reports advisory board work for NovoNordisk, Allergan and Neurocrine, and has lectured at an educational event for Amgen, outside the submitted work. Conflict of interest: S.E. Straus has nothing to disclose.

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