A cluster randomized controlled trial of an electronic medical record-based pathway for pediatric asthma in primary care in Alberta.

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.