JMIR Publications

ABSTRACT

Background:

Despite national asthma care guidelines, care gaps persist between best practice and clinical practice, contributing to poor health outcomes. The Provider Asthma Assessment Form (PAAF) is an electronic asthma management and Knowledge Translation (KT) tool with an embedded decision support algorithm for severe and/or uncontrolled asthma, designed to support evidence-based asthma management.

Objective:

In this study we aimed to document baseline asthma practice patterns, and to determine whether the broader intervention of PAAF integration into a primary care electronic medical record (EMR) improves evidence-based asthma diagnosis and management.

Methods:

We performed a single-centre pre-post observational study at an academic Family Health Team in Kingston, Ontario, Canada. Retrospective baseline data was collected for two years prior to PAAF implementation, from Jan 2018 - Dec 2019. Prospective, post-intervention data was collected from Oct 2022 – July 2024. A validated adult asthma EMR case definition was applied to EMR data to identify suspected or objectively confirmed asthma cases for both data sets, on which detailed manual chart abstractions were performed. A data extraction was performed for completed PAAFs.

Results:

There were 230 patients in the retrospective baseline and 143 patients in the post-implementation cohort. Overall, 31.3% in baseline versus 23.8% post-implementation had confirmed asthma. There were significantly more pulmonary function tests (PFTs) requested after implementation of the PAAF (49.0% post-implementation; 30.9% baseline, P<.001). A significantly higher percent of post-implementation patients were on single inhaler controller and reliever therapy (21.7% post-implementation, 0.9% baseline, P<.0001), ICS/LABA therapy (25.2% post-implementation, 14.8% baseline, P=.0143), and were on an ICS if their asthma was uncontrolled (62.2% post-implementation, 43.5% baseline, P=.0017). Barriers were significantly more commonly addressed post-implementation (16.8% post-implementation, 4.8% baseline, P=.0002). A significantly higher average number of asthma control parameters was documented when the PAAF was used (5.4±1.9 PAAF, 2.3±1.2 manual chart abstraction [mean±SD], P<.0001). Care as assessed by key Primary Care – Asthma Performance indicators (PC-APIs©) showed improvement in the post-implementation cohort which did not reach statistical significance.

Conclusions:

The multi-faceted intervention of implementing the PAAF in this primary care practice was associated with improved documentation of diagnosis status and asthma control parameters, and improved adherence with evidence-based recommendations for care, such as use of PFTs and addressing barriers to effective asthma management. However, uptake was low and key asthma care gaps were still common. Future directions should involve evaluating the impact of the PAAF on care and outcomes after widespread implementation in primary care settings and investigating methods to increase user uptake of the PAAF.