Clinician reminders in electronic health records improve pediatric asthma care
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Key takeaways:
- The intervention group had greater change in odds of preventive medication use at all follow-up visits.
- The intervention group had lower change in odds of any asthma-related health care usage at 12 months.
WASHINGTON — Reminders included in electronic health records improved the use of preventive medication and reduced health care utilization for asthma, according to a study presented at the Pediatric Academic Societies Meeting.
These reminders also eased caregiver concerns about these medications, Marina Reznik, MD, MS, vice chair for clinical and community-based research at Albert Einstein College of Medicine, Children’s Hospital at Montefiore, and colleagues wrote.
“We know from prior research that asthma guidelines improve patient outcomes and decrease morbidity. However, inconsistent implementation of guidelines and poor clinician adherence to these guidelines likely contribute to preventable illness,” Reznik told Healio.
Lack of time as well as a lack of clinician awareness of these guidelines are main barriers that clinicians face during office visits, Reznik continued, adding that prompting and decision support in EHR can improve preventive care and address these barriers.
However, she said, few studies have evaluated the effects of these prompts on asthma care and its outcomes in clinical settings.
The cluster randomized controlled trial involved 530 children age 2 to 12 years with persistent or uncontrolled asthma at 18 pediatric and family medicine clinics in the Montefiore Health System in the Bronx, New York, from 2017 through 2022.
The researchers randomly assigned clinics into one of two groups: one in which clinicians were prompted with guideline-based decision support that was part of EHR and appeared in the records during the visit or one in which there was no use of any prompts.
Nursing staff at both groups screened patients for asthma severity and level of control with questions that assessed patient and risk that were built into the EHR. Caregivers completed phone surveys at 3, 6, 9 and 12 months after the visit.
The intervention and control populations included 265 children each, with similar demographic characteristics and asthma symptoms at baseline.
Compared with the control group, the intervention group had greater changes in odds for preventive medication use at 3 months (= 0.38; 95% CI, 0.05-0.72), 9 months (= 0.49; 95% CI, 0.14-0.84) and 12 months (= 0.4; 95% CI, 0-0.79).
Also, the caregivers in the intervention group reported less concern about preventive medications at 3 months (= –0.93; 95% CI, –1.66 to –0.2). At 12 months, the intervention group had lower changes in the odds for any asthma-related health care utilization than the control group (= –0.53; 95% CI, –1.03 to –0.03).
However, the groups did not experience any difference in asthma symptoms at 12 months, the researchers said.
“While we found no differences between groups in asthma outcomes, incorporating systematic screening and provider prompting at the time of a visit improved preventive medication use and decreased caregiver’s concerns about these medications,” Reznik said.
“Our results demonstrate that additional support is needed for children with persistent or uncontrolled asthma to reduce asthma morbidity,” she added.
Also, Reznik noted that consistent use of the asthma management guidelines at every clinic visit is recommended for optimal asthma care.
“Electronic reminders and decision support can be helpful tools to help clinicians follow the guidelines,” Reznik said. “We are continuing with addition data analyses to better understand intervention implementation, processes and outcomes.”
For more information:
Marina Reznik, MD, MS, can be reached at mreznik@montefiore.org.