Evaluating the EAPOC-COPD System (EAPOC-COPD)

Bringing Evidence to the Point-of-Care in Chronic Obstructive Pulmonary Disease: The EAPOC-COPD System

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.

Study Overview

• Status: Not yet recruiting
• Conditions: COPD
• Intervention / Treatment: Behavioral: EAPOC-COPD

• Study Type: Interventional
• Enrollment (Estimated): 25
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Andrew Kouri, MD, PhD; Phone Number: 2045 (416)-864-6060; Email: andrew.kouri@unityhealth.to

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M5B 1W8
      • St. Michael's Hospital, Unity Health Toronto
      • Contact: Andrew Kouri, MD, PhD; Phone Number: 2045 (416)-864-6060; Email: andrew.kouri@unityhealth.to

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: EAPOC-COPD system; The EAPOC-COPD system consists of: 1) a smart phone / tablet app or PC-based questionnaire which collects information directly from patients upon prompting; and 2) a point-of-care CDSS 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 (by pharmacists or through provider sign-back), 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.

Behavioral: EAPOC-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

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Implementation outcomes - System usage	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	During the 1 year intervention period
Implementation outcome - usability	Perceived system usability (pharmacy team members, will be collected by using the 10-item System Usability Scale - SUS	During the 1 year intervention period
Implementation outcome - system satisfaction	satisfaction with/willingness to continue using the system (pharmacy team/patients), collected by questionnaire	During the 1 year intervention period
Implementation outcome - Prescription sign-back	Proportion of prescriptions sent to doctors for sign-back that are sent back, will be collected from pharmacy chart system review	During the 1 year intervention period
Implementation outcome - perceived pharmacist cost-benefit	Revenue for time spent, perceived value of customer loyalty realized, and compared to the baseline period, collected by questionnaire	During the 1 year intervention period
Implementation outcome - revenue metrics	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	During the 1 year intervention period

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Effectiveness outcomes - COPD symptoms are exacerbation risk	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	During the 1 year intervention period compared to the year prior
Effectiveness outcome - COPD medications adjusted	the proportion of visits in the intervention compared to baseline period in which patients had COPD medications adjusted, as determined by pharmacy chart review	During the 1 year intervention period compared to the year prior
Effectiveness outcome - action plans created	the proportion of visits in the intervention compared to baseline period in which patients had an action plan created, based on pharmacy chart review	During the 1 year intervention period compared to the year prior
Effectiveness outcome - specialist referral	The proportion of patients who had a specialist referral made	During the 1 year intervention period compared to the year prior

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Process metrics: provider uptake of EAPOC-COPD	CDSS access proportion measured by system audit	From start of intervention period to study end at 56 weeks
Process metrics: patient uptake of EAPOC-COPD	Patient questionnaire access proportion measured by system audit	From start of intervention period to study end at 56 weeks
User satisfaction questionnaire - providers	Questionnaires will collect demographic information and probe perceived utility of the system, readiness to adopt the system, satisfaction, and possible improvements, using open-ended and Likert scale-type questions (including the System Usability Scale - SUS)	From week 52 to week 56 of the trial
User satisfaction questionnaire - patients	Questionnaires will collect demographic information and probe perceived utility of the system, readiness to adopt the system, satisfaction, and possible improvements, using open-ended and Likert scale-type questions (including the System Usability Scale - SUS)	2 weeks after first access to patient portal/app

Collaborators and Investigators

• Sponsor: Women's College Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): July 1, 2028
• Study Completion (Estimated): September 1, 2028

Study Registration Dates

• First Submitted: February 20, 2025
• First Submitted That Met QC Criteria: February 25, 2025
• First Posted (Actual): February 28, 2025

Study Record Updates

• Last Update Posted (Actual): May 18, 2026
• Last Update Submitted That Met QC Criteria: May 12, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: COPD; clinical decision support
• Additional Relevant MeSH Terms: Pathologic Processes; Chronic Disease; Disease Attributes; Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Obstructive; Pathological Conditions, Signs and Symptoms; Pulmonary Disease, Chronic Obstructive
• Other Study ID Numbers: PSI Grant Number: 24-08

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: We will not be collecting individual patient data, but rather provider behaviour change data

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No