Accepted for/Published in: JMIR Formative Research
Date Submitted: Sep 16, 2022
Date Accepted: Jan 12, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Integrating user preferences for asthma tools and clinical guidelines into primary care electronic medical records: A mixed-methods approach
ABSTRACT
Background:
Suboptimal adherence to asthma management guidelines contributes to poor outcomes. Integration of electronic tools (eTools) into electronic medical records (EMRs) represents a knowledge translation opportunity to support best practice, however, many barriers exist.
Objective:
The purpose of this study was to determine how best to integrate evidence-based asthma eTools into primary care EMRs across Ontario and Canada.
Methods:
Two focus groups comprised of physicians, patients, allied health professionals considered experts in primary care, asthma, and EMRs were convened. One focus group also included a patient participant. Focus groups used a semi-structured discussion-based format to consider optimal methods for integrating asthma eTools into EMRs. The first focus group attended to the incorporation of asthma indicators into EMRs using eTools and included a survey on the most useful indicators for asthma diagnosis and management. The second focus group concentrated on how to integrate eTools for asthma into primary care and was accompanied by a questionnaire on eTools. Focus group discussions were recorded and analyzed using thematic qualitative analysis and responses to focus group questionnaires were assessed through descriptive quantitative analysis.
Results:
Seven themes were identified: (1) design outcome-oriented tools; (2) gain stakeholder trust; (3) facilitate open lines of communication; (4) prioritize the end-user, (5) strive for efficiency; (6) ensure adaptability; and (7) develop within existing workflows. Quantitative analysis of the asthma indicator survey responses identified the asthma performance indicators perceived to be most useful in primary care, including smoking cessation support, monitoring by objective measures, and the number of emergency department visits. Quantitative analysis of the eTool survey found the Asthma Action Plan Wizard and Electronic Asthma Quality of Life Questionnaire (eAQLQ) to be the most useful in primary care practices.
Conclusions:
eTools for asthma care provide a unique opportunity to improve adherence to best-practice guidelines in primary care. Strategies and themes identified in this study can be leveraged to overcome barriers associated with asthma eTool integration into primary care EMRs.
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