COPD
Conditions
Keywords
COPD, clinical decision support
Brief summary
This study evaluates the implementation and impact of the Evidence-at-the-Point-of-Care Chronic Obstructive Pulmonary Disease (EAPOC-COPD) system, a computerized clinical decision support system designed to improve the quality of COPD care delivered in community pharmacies. Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and healthcare utilization, and significant gaps persist in key evidence-based practices, including symptom and exacerbation risk assessment, appropriate pharmacotherapy, provision of COPD action plans, and referral for specialist care. The EAPOC-COPD system builds on a previously validated asthma platform and provides pharmacists with guideline-based decision support through a structured patient questionnaire and point-of-care recommendations, including treatment optimization and generation of personalized action plans. This study will be conducted across six community pharmacies implementing the EAPOC-COPD system as part of a quality improvement initiative. Using a quasi-experimental interrupted time series design, outcomes during a 12-month intervention period will be compared to a 12-month pre-intervention baseline period. The study will evaluate both implementation outcomes (including system uptake, usability, feasibility, and acceptability among pharmacy teams and patients) and effectiveness outcomes. Effectiveness outcomes include improvements in guideline-based COPD care processes, such as rates of symptom and exacerbation risk assessment, optimization of pharmacotherapy, provision of COPD action plans, and appropriate referral for specialist care. Results from this study will inform the scalability and broader implementation of pharmacy-based clinical decision support tools to enhance chronic disease management and support the expanding role of pharmacists in delivering evidence-based COPD care.
Interventions
BEHAVIORALEAPOC-COPD
The EAPOC-COPD system consists of: 1) a smart phone / tablet app or Personal Computer-based questionnaire which collects information directly from patients upon prompting; 2) a point-of-care clinical decision support system that wirelessly receives and processes questionnaire data in order to produce a symptom severity/exacerbation risk assessment, medication change recommendation, and COPD action plan, all of which is made available to pharmacy providers electronically. Once approved, the personalized COPD action plan is automatically populated within the patient app/portal, enabling anywhere/anytime access for patients. Patients are also provided with educational resources within their app/portal, designed to improve health literacy, inhaler technique, and adherence to their action plan
Sponsors
Women's College Hospital
Study design
Allocation
NA
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Masking description
Blinding will not be possible for participating providers or patients, given the nature of the EAPOC-COPD intervention as a point-of-care clinical decision support system integrated into routine care workflows.
Intervention model description
Interrupted time series study
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
The study will involve two groups of participants: pharmacy team members and adult patients with COPD who interact with the EAPOC-COPD system during pharmacy encounters. Pharmacy team participants will include pharmacists, registered pharmacy technicians, pharmacy assistants, and students working at one of the six participating community pharmacies. Individuals will be eligible if they are employed at one of the participating sites, have used the EAPOC-COPD system during the study period, are able to provide informed consent, and are able to complete an electronic questionnaire in English. Individuals will be excluded if they have not used the system during the study period or decline to participate. Patient participants will include adults aged 18 years or older who interact with the EAPOC-COPD system during routine pharmacy care. Eligible patients will be those identified by pharmacy staff as receiving COPD-related care and who complete the EAPOC-COPD patient questionnaire during their pharmacy encounter. Patients must have also indicated willingness to be contacted regarding research participation and be able to provide informed consent. Patients who are under 18 years of age, otherwise unable to provide informed consent, or who decline participation will be excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Implementation outcomes - System usage | During the 1 year intervention period | System usage (pharmacy team/patients) is a composite outcome that reflects the different usage metrics available in our system, including nature of visit (virtual vs in-person), specific content accessed, and time required for access/documentation |
| Implementation outcome - usability | During the 1 year intervention period | Perceived system usability (pharmacy team members, will be collected by using the 10-item System Usability Scale - SUS |
| Implementation outcome - system satisfaction | During the 1 year intervention period | satisfaction with/willingness to continue using the system (pharmacy team/patients), collected by questionnaire |
| Implementation outcome - Prescription sign-back | During the 1 year intervention period | Proportion of prescriptions sent to doctors for sign-back that are sent back, will be collected from pharmacy chart system review |
| Implementation outcome - perceived pharmacist cost-benefit | During the 1 year intervention period | Revenue for time spent, perceived value of customer loyalty realized, and compared to the baseline period, collected by questionnaire |
| Implementation outcome - revenue metrics | During the 1 year intervention period | Composite outcome made up of proportion of patients for whom a pharmaceutical opinion and/or MedsCheck was successfully billed, total average revenue per eligible patient (pharmaceutical opinions, MedsChecks, markups, dispensing fees) and overall reimbursement for time spent |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Effectiveness outcomes - COPD symptoms are exacerbation risk | During the 1 year intervention period compared to the year prior | the proportion of visits in the intervention compared to baseline period in which patients had COPD symptoms and exacerbation risk assessed, as determined by pharmacy chart review |
| Effectiveness outcome - COPD medications adjusted | During the 1 year intervention period compared to the year prior | the proportion of visits in the intervention compared to baseline period in which patients had COPD medications adjusted, as determined by pharmacy chart review |
| Effectiveness outcome - action plans created | During the 1 year intervention period compared to the year prior | the proportion of visits in the intervention compared to baseline period in which patients had an action plan created, based on pharmacy chart review |
| Effectiveness outcome - specialist referral | During the 1 year intervention period compared to the year prior | The proportion of patients who had a specialist referral made |
Countries
Canada
Contacts
CONTACTAndrew Kouri, MD, PhD
Outcome results
None listed