The Electronic Asthma Action Plan System for Implementation in Primary Care
eAAPS
1 other identifier
interventional
19
1 country
3
Brief Summary
Asthma is a common and potentially fatal chronic disease. An asthma action plan (AAP) is a written plan produced by a physician for a patient with asthma, to provide education and guidelines for self-management of worsening asthma symptoms. Studies have shown that AAPs effectively improve asthma control, but physicians fail to provide AAPs due to lack of time and adequate skills. Physicians also often fail to determine if their patients have good asthma control, and to adjust medications in response to patients' control level. The investigators propose to develop and test a computerized tool that will help physicians to determine if their patients' asthma is well controlled, advise them on medication changes required according to the current level of control, and automatically generate an electronic version of the AAP, all based on patient responses to a questionnaire. The investigators hope that this system will eliminate the barriers that physicians face in determining asthma control, adjusting medications, and delivering an AAP, and will increase the frequency with which physicians are able to achieve these goals in patients with asthma. The objectives of the study are to determine the impact of this system on asthma action plan delivery by primary care physicians, the frequency of checking control level, and the frequency and appropriateness of asthma medication changes (in accordance with control). We will also attempt to determine the impact of the system on hospitalisations, emergency room (ER) visits, unscheduled visits to the doctor, total visits to the doctor, days off work or school, nocturnal asthma symptoms, daytime asthma symptoms, daytime rescue puffer use, and quality of life, and to measure physicians' perceptions of and satisfaction with the system.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at below P25 for not_applicable asthma
Started Jul 2012
3 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
February 16, 2010
CompletedFirst Posted
Study publicly available on registry
February 17, 2010
CompletedStudy Start
First participant enrolled
July 1, 2012
CompletedPrimary Completion
Last participant's last visit for primary outcome
August 1, 2014
CompletedStudy Completion
Last participant's last visit for all outcomes
August 1, 2014
CompletedResults Posted
Study results publicly available
September 13, 2019
CompletedSeptember 13, 2019
September 1, 2019
2.1 years
February 16, 2010
September 6, 2018
September 10, 2019
Conditions
Outcome Measures
Primary Outcomes (1)
Number of Participants to Whom an AAP (Asthma Action Plan) Was Delivered by the Clinician
Number of eligible patients to whom an AAP was delivered by the physician during the intervention period (52 weeks) compared to the baseline period (52 weeks) Predictor model to include: clinic, appointment provider practitioner type, prior objective diagnosis of asthma, documented physician diagnosis of asthma, presenting complaint type, billing physician (most responsible physician/other), previous emergency department (ED) visits/hospitalizations for asthma, and current asthma control
24 months
Secondary Outcomes (9)
The Impact of the eAAPS on Patient-relevant Outcomes Including Hospitalisations, Emergency Room Visits, Unscheduled & Total Visits to the Doctor, Days Off Work/School, Nocturnal/Daytime Asthma Symptoms, Daytime Rescue Bronchodilator Use & Quality of Life.
Every 2 weeks for 6 months
Asthma Control Assessment
24 months
Medication Escalations
24 months
Appropriate Medication Changes
24 months
On Treatment Analysis
During the 12 month intervention period
- +4 more secondary outcomes
Study Arms (1)
Electronic Asthma Action Plan System
EXPERIMENTALElectronic Asthma Action Plan System (eAAPS)
Interventions
The electronic asthma action plan system consists of a tablet device in the physician waiting room which participants use to complete a simple questionnaire, a computerized clinical decision support system which then processes these data to produce a set of asthma care recommendations for the clinician, and finally, a printable asthma action plan that is given to patients, along with the URL for an asthma education website.
Eligibility Criteria
You may qualify if:
- Eligible physicians will include all primary care physicians at the 4 sites.
- Eligible patients will include:
- patients with asthma, as determined by a validated electronic chart record search algorithm for asthma and on an asthma medication \[but not a Chronic Obstructive Pulmonary Disease (COPD) medication\] within 1 year;
- patients \>/= 16 years of age who understand English
You may not qualify if:
- Pregnant patients will be excluded given that conventional AAP recommendations may not be appropriate in this population.
- Any patient deemed to have cognitive limitations or a life expectancy of \< 1 year
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (3)
Wise Elephant Family Health Team
Brampton, Ontario, L6X 1N3, Canada
McMaster Family Health Team
Hamilton, Ontario, L8N 3Z6, Canada
St. Michael's Hospital
Toronto, Ontario, M5B 1W8, Canada
Related Publications (1)
Price C, Agarwal G, Chan D, Goel S, Kaplan AG, Boulet LP, Mamdani MM, Straus SE, Lebovic G, Gupta S. Large care gaps in primary care management of asthma: a longitudinal practice audit. BMJ Open. 2019 Jan 29;9(1):e022506. doi: 10.1136/bmjopen-2018-022506.
PMID: 30696669DERIVED
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Limitations and Caveats
An interrupted time series design is vulnerable to temporal factors that may have affected asthma care behaviour. We report on behavioural rather than health outcomes in this study.
Results Point of Contact
- Title
- Dr. Samir Gupta
- Organization
- St. Michael's Hospital
Study Officials
- PRINCIPAL INVESTIGATOR
Samir Gupta, MDCM
Unity Health Toronto
Publication Agreements
- PI is Sponsor Employee
- No
- Restrictive Agreement
- No
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- NA
- Masking
- NONE
- Purpose
- SUPPORTIVE CARE
- Intervention Model
- SINGLE GROUP
- Sponsor Type
- OTHER
- Responsible Party
- SPONSOR
Study Record Dates
First Submitted
February 16, 2010
First Posted
February 17, 2010
Study Start
July 1, 2012
Primary Completion
August 1, 2014
Study Completion
August 1, 2014
Last Updated
September 13, 2019
Results First Posted
September 13, 2019
Record last verified: 2019-09