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A cluster randomized controlled trial of an electronic medical record-based pathway for pediatric asthma in primary
Melissa L Potestio1, Heather Sharpe2, David W Johnson2
1Department of Pediatrics (Potestio, Johnson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Sharpe), University of Alberta, Edmonton, Alta.; Ottawa Hospital Research Institute and Department of Medicine (Grimshaw), University of Ottawa, Ottawa, Ont.; Data and Analytics (Faris, Duan), Alberta Health Services; Health Quality Council of Alberta (Pow), Calgary, Alta.; Department of Family Medicine, Faculty of Medicine & Dentistry (Cave), University of Alberta, Edmonton, Alta. mlpotest@ucalgary.ca.
Insights
A new electronic medical record (EMR) pathway for pediatric asthma did not increase controller medication prescriptions or dispensing in primary care. Future interventions may need active alerts and urgent care integration for better asthma management.
Area of Science:
- Pediatric Asthma Management
- Clinical Informatics
- Primary Care Practice Improvement
Background:
- Primary care physicians often underassess asthma control and underprescribe controller medications for children.
- A pediatric asthma clinical pathway integrated into electronic medical records (EMR) was developed to address these gaps.
- The study aimed to evaluate the impact of this EMR-based pathway on controller medication use in pediatric asthma patients.
Purpose of the Study:
- To assess the effectiveness of an EMR-embedded pediatric asthma clinical pathway on controller medication prescription and dispensing.
- To evaluate a multifaceted intervention including EMR pathway, physician education, and staff training for asthma management in primary care.
Main Methods:
- A cluster randomized controlled trial was conducted in primary care practices in Alberta using Wolf or Med Access EMRs.
- The intervention group received an EMR-based asthma pathway, web-based education, and staff training; the control group received standard care.
- Data were extracted from EMRs and administrative datasets, with primary outcomes being the proportion of children prescribed and dispensed controller medications.
Main Results:
- The intervention did not significantly increase the proportion of children prescribed controller medications (mean difference 4.3%, 95% CI -2.0% to 10.5%).
- Similarly, there was no significant change in the proportion of children dispensed controller medications (mean difference -0.1%, 95% CI -7.1% to 6.9%).
Conclusions:
- The multifaceted EMR-based intervention did not improve controller medication prescribing or dispensing for pediatric asthma in primary care.
- Effective interventions may necessitate active alerts within EMRs and targeted strategies for walk-in and urgent care settings.
Background:
Primary care physicians, who manage the care of most children with asthma, often do not optimally assess disease control, prescribe asthma controller medications, or provide family asthma education. We developed a pediatric asthma clinical pathway embedded in an electronic medical record (EMR) for use by primary care practices, and we sought to evaluate its effects on prescription and use of asthma controller medication for children with asthma.
Methods:
We conducted a cluster randomized controlled trial, enrolling primary care practices in Alberta that used Wolf or Med Access EMRs, and managed at least 50 children with asthma. The multifaceted intervention included an EMR-based pathway for pediatric asthma, Web-based education modules for physicians, and train-the-trainer sessions for practice staff to provide patient education. The control intervention was standard care. We extracted study data from participating practices' EMRs, and standard emergency department and hospital administrative data sets. The primary and main secondary outcomes were improvement in the proportion of children prescribed and dispensed controller medications, respectively.
Results:
Eleven practices were randomly assigned to each of the intervention and control groups. The intervention did not significantly change the proportion of children prescribed (mean difference 4.3%, 95% confidence interval [CI] -2.0% to 10.5%) or dispensed (mean difference -0.1%, 95% CI -7.1% to 6.9%) controller medications.
Interpretation:
Our multifaceted intervention did not improve the proportion of children in primary care who were prescribed or dispensed a controller medication for asthma. These results suggest that such interventions may require active alerts and targeting of walk-in and urgent care clinics to have a meaningful impact on clinical practice.
Trial Registration:
Clinicaltrials.gov NCT02481037.
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