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 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 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-center pre- and postobservational study at an academic Family Health Team in Kingston, Ontario, Canada. Retrospective baseline data were collected for 2 years prior to PAAF implementation from January 2018 to December 2019. Prospective postintervention data were collected from October 2022 to July 2024. A validated adult asthma EMR case definition was applied to EMR data to identify suspected or objectively confirmed asthma cases for both datasets, 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 postimplementation cohort. Overall, 31.3% (n=72) of patients at baseline versus 23.8% (n=34) at postimplementation had confirmed asthma. There were significantly more pulmonary function tests requested after the implementation of the PAAF (postimplementation: n=70, 49%; baseline: n=71, 30.9%; P<.001). A significantly higher percent of postimplementation patients were on single inhaler controller and reliever therapy (postimplementation: n=31, 21.7%; baseline: n=2, 0.9%; P<.001), inhaled corticosteroid/long-acting β-2 agonist therapy (postimplementation: n=36, 25.2%; baseline: n=34, 14.8%; P=.01), and inhaled corticosteroid if their asthma was uncontrolled (postimplementation: n=69, 62.2%; baseline: n=100, 43.5%; P=.002). Barriers were significantly more commonly addressed after implementation (postimplementation: n=24, 16.8%; baseline: n=11, 4.8%; P<.001). A significantly higher average number of asthma control parameters was documented when the PAAF was used (PAAF: mean 5.4, SD 1.9; manual chart abstraction: mean 2.3, SD 1.2; P<.001). Care as assessed by key Primary Care-Asthma Performance Indicators showed improvement in the postimplementation cohort, which did not reach statistical significance. CONCLUSIONS: The multifaceted 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 the use of pulmonary function tests 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.