Promoting Evidence-Based Asthma Care Using Digital Knowledge Translation Tools: Impact of the Provider Asthma Assessment Form and Severe Asthma Algorithm (PEACKT-PAAF)
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Authors
McFarlane, Matheson Louise
Date
2024-09-04
Type
thesis
Language
eng
Keyword
Asthma , eTools , EMRs , Knowledge Translation , Pulmonary Function Testing , Severe Asthma , Primary Care , Canadian Thoracic Society Guidelines , Evidence-based practice
Alternative Title
Abstract
Background: Despite national asthma care guidelines, gaps persist between best practice and clinical practice. Electronic Medical Records (EMRs) provide a unique opportunity to integrate novel eTools at the point-of-care. The Provider Asthma Assessment Form (PAAF) is an electronic asthma management tool with an embedded decision support algorithm for severe/uncontrolled asthma, designed to support evidence-based practice.
Purpose: The purpose of this study was to determine whether PAAF integration into a primary care EMR improves evidence-based asthma diagnosis and management. We also aimed to evaluate the perceived utility, provider satisfaction, and barriers/enablers to the implementation of the PAAF.
Methods: We performed a single-centre pre-post observational study at an academic family health in Kingston, Ontario. Retrospective baseline data (Jan 2018 - Dec 2019) and post-implementation data (Jan – Dec 2023) were collected. A validated adult asthma EMR case definition was applied to identify asthma cases, on which detailed manual chart abstractions were performed. A data extraction was performed for completed PAAFs (Oct 2022 – July 2024). A survey was administered post-implementation to evaluate perceived utility, provider satisfaction, and enablers/barriers to using the PAAF.
Results: Overall, 31.3% in baseline (n=72) versus 23.8% (n=34) post-implementation had confirmed asthma. Significantly more pulmonary function tests (PFTs) were requested after implementation of the PAAF (49.0% post-implementation; 30.9% baseline, p=0.0006). Care as assessed by key Primary Care - Asthma Performance Indicators (PC-APIs©) showed tendencies towards improvement in the post-implementation cohort. A significantly higher average number of asthma control parameters was documented when the PAAF (n=12) was used compared to manual chart abstractions (n=366) (5.4±1.9 PAAF, 2.3±1.2 manual chart abstraction [mean±SD], p=<0.0001). Most providers were satisfied that the PAAF was helpful in clinical practice, aided their decision making, and was user friendly. Several barriers to implementation were identified.
Conclusions: There were significant improvements in asthma-specific documentation and adherence with key evidence-based recommendations for care following PAAF implementation. However, uptake was low and key asthma care gaps were still common. Although the PAAF was perceived to be a useful eTool, barriers limited user uptake. Lessons learned from the PAAF can inform the development and implementation of novel eTools in primary care EMRs.
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Attribution-NonCommercial 4.0 International
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NonCommercial 4.0 International