The Electronic Asthma Management System in Pharmacies (eAMS-Pharm)

The Electronic Asthma Management System in Pharmacies (eAMS-Pharm)

The goal of this study is to assess the effect of an electronic asthma management system in pharmacies (eAMS-Pharm) on asthma control assessment, asthma medication adjustment, asthma action plan delivery, and prompting for specialist referral in severe asthma. The study assesses the differences on pharmacy processes (affecting both the pharmacy team and patients) and pharmacy-delivered care using an interrupted time-series analysis (six-months before vs. six-months after the introduction of eAMS-Pharm in study pharmacy sites).

The eAMS-Pharm uses patient data (asthma control, asthma flare-up risk, and current medications) to provide clinical decision support to pharmacists, empowering them to bridge existing gaps between guideline-recommended asthma care and patient care received.

Study Overview

• Status: Enrolling by invitation
• Conditions: Asthma; Pharmacy; Computerized Decision Support System; Asthma Management
• Intervention / Treatment: Behavioral: Pharmacy Clinical Decision Support System for Asthma Management

Detailed Description

Asthma is the third most common chronic disease in adults and is increasing in prevalence. Although effective therapies exist and well-controlled asthma is achievable in most patients, studies demonstrate that up to 90% of Canadians with asthma are poorly controlled. This poor control and associated health system burden are attributable to 4 major gaps in care: 1) failure to ascertain asthma control according to guideline criteria; 2) failure to escalate pharmacotherapy in response to suboptimal control; 3) failure to provide a written asthma action plan (AAP) (a personalized plan produced by a health care professional for a patient, providing education and guidance for self-management of flares); and 4) failure to refer patients with severe asthma to specialty care for biologic therapies (these were 4 of the 6 quality statements in Health Quality Ontario's Asthma Quality Standards).

The Electronic Asthma Management System (eAMS) is a validated tool that has the potential to address the 4 major gaps in care. The eAMS consists of a web-based portal-based e-questionnaire, which collects asthma parameters directly from patients. A point-of-care Computerized Decision Support System (CDSS) receives and processes questionnaire data to produce guideline-based decision support such as assessments of asthma control, relevant medication change recommendations, and a personalized asthma action plan (AAP). There are also web-based education resources in the patient portal. The eAMS was proven to improve asthma management in primary care across these care gaps and is used in 16 primary care clinics, with ~215 providers and ~7200 patients with asthma. Now, with the increasingly critical role that pharmacists are playing in Canada's healthcare ecosystem, the eAMS can also be used to empower pharmacists to help optimize chronic disease care.

Pharmacists' scope of practice is growing rapidly in Ontario and across Canada. At the same time, asthma control remains suboptimal for millions of Canadians. Furthermore, the eAMS has been extensively studied and validated as an optimal tool to improve asthma management in primary care. The use of the eAMS in pharmacies presents a unique opportunity to involve pharmacists in chronic disease care while also reducing the burden on primary care. To address limited primary care access and given rapid the expansion of pharmacists' role of in care delivery, the investigators adapted the platform to build the eAMS-Pharm - a chronic disease quality improvement tool for pharmacists. The results of this study will inform the broader implementation of the eAMS across pharmacies and similar knowledge translation tools in pharmacies in the future.

• Study Type: Interventional
• Enrollment (Estimated): 100
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Ajax, Ontario, Canada, L1L 2J5
      • Medical Place Pharmacy
    • Niagara Falls, Ontario, Canada, L2J 2K5
      • LiveWell Pharmacy
    • Waterloo, Ontario, Canada, N2L 2R5
      • Westmount Place Pharmacy

Participation Criteria

Eligibility Criteria

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

Description

• Eligible patients would be those who have asthma and are seen at one of the three study pharmacies during the study period
• Eligible pharmacy team members would be staff (pharmacists/RPhTs/assistants/students) at any one of the three study pharmacies

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control - None; A retrospective, pharmacy chart review will assess pharmacy-delivered care in the six-month pre-intervention period.
Active Comparator: Intervention - The Electronic Asthma Management System in Pharmacies (eAMS-Pharm); Throughout the intervention period, the eAMS-Pharm will be provided to pharmacists/RPhTs/assistants/students (for use in eligible patients).	Behavioral: Pharmacy Clinical Decision Support System for Asthma Management; A pharmacy clinical decision support system that generates individualized advice for asthma patients is provided to the pharmacist/RPht/assistant/student.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Medication adjustments	Using pharmacist chart review, the investigators will assess the proportion and trend in patients receiving medication adjustments	12 months, broken into individual time series periods
Asthma control assessment	Using pharmacist chart review, the investigators will assess the proportion and trend of patients receiving asthma control assessment by guideline criteria	12 months, broken into individual time series periods
Asthma action plan creation	Using pharmacist chart review, the investigators will assess the proportion and trend of asthma action plans being created for patients	12 months, broken into individual time series periods

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
System usage: virtual and in-person visit frequency	Using pharmacist chart review, investigators will assess the number of times the system was used in virtual (i.e., telemedicine) visits and in in-person visits	6 months
System usage: content access frequency	Using system analytics, investigators will assess the type of content accessed (clinical tools, clinical decisions, educational materials) by patients and pharmacy teams	6 months
System usage: patient engagement frequency, by method	Using system analytics, investigators will assess the number of patients who engaged with the system by the programmatic (mass invite) method, or as a walk-in patient following programmatic invitations	6 months
System usage: time required for access and documentation	Using system analytics, investigators will assess how long it takes pharmacy teams to access and complete clinical decision making within the system. Last screen timestamp minus first screen timestamp will be used to measure time	6 months
Quantitative patient Likert-Scale questionnaire	Exclusively throughout the intervention, electronic questionnaires developed by the investigators will be sent to consenting patients to assess quantitative patient feedback on system functionality and care quality received, as 5-point Likert scales. Multiple choice and yes/no questions will also bee used to determine demographics and relevant asthma diagnosis information	6 months
Qualitative patient free-text feedback questionnaire	Exclusively throughout the intervention, electronic questionnaires developed by the investigators will be sent to consenting patients to assess qualitative patient feedback on benefits and drawbacks of the system, as measured through two free-text questions	6 months
Pharmacy team feedback: 10-item System Usability Scale - SUS	Exclusively throughout the intervention, electronic questionnaires developed by the investigators will be sent to consenting pharmacy team members to assess feedback on system usability, as measured by The System Usability Scale (SUS), a 10-item 5-point Likert scale	6 months
Quantitative pharmacy Likert-Scale questionnaire	Exclusively throughout the intervention, electronic questionnaires developed by the investigators will be sent to consenting pharmacy team members to assess quantitative pharmacy team feedback on technology interest, role of pharmacies in chronic disease care and asthma action plans, system functionality, and benefits and drawbacks of the system on pharmacy workflows, as measured with 5-point Likert scales	6 months
Qualitative pharmacy free-text feedback questionnaire	Exclusively throughout the intervention, electronic questionnaires developed by the investigators will be sent to consenting pharmacy team members to assess qualitative pharmacy team feedback on system usage, as measured through 6 free text questions. To supplement the outcome of revenue metrics, the pharmacy team feedback questionnaire will also ask pharmacy team members to estimate revenue for time spent	6 months
Prescription/action plan sign-back proportions	Using pharmacist chart review, the investigators will assess the proportion of prescriptions/action plans which receive sign-back from prescribers in each analysis period	12 months, broken into individual time series periods
Revenue metrics: pharmaceutical opinion proportion	Using pharmacist chart review, the investigators will assess the proportion of eligible visits for which a pharmaceutical opinion was successfully billed	12 months, broken into individual time series periods
Revenue metrics: MedsCheck proportion	Using pharmacist chart review, the investigators will assess the proportion of eligible visits for which a MedsCheck was successfully billed	12 months, broken into individual time series periods
Revenue metrics: total dollar revenue per patient	Using pharmacist chart review, the investigators will assess the total average revenue per eligible patient by summing pharmaceutical opinion, MedsChecks, markups, and dispensing fees	12 months, broken into individual time series periods
Revenue metrics: dollar reimbursement for time spent in system	Using pharmacist chart review, the investigators will assess the overall reimbursement for time pharmacy team members spent in the system. To measure, investigators will sum the total revenue per patient and divide by time spent in the system for each patient over visits. An average will be calculated across all patients	6 months
Specialist referral prompt proportion	Using pharmacist chart review, the investigators will assess the proportion of severe asthma patients, as identified by medications currently prescribed and filled, and who are not already seeing a specialist, for whom a prompt for specialist referral was sent to the prescriber	12 months, broken into individual time series periods

Collaborators and Investigators

• Sponsor: Unity Health Toronto

Publications and helpful links

Helpful Links

• eAMS-Pharm web page

Study record dates

Study Major Dates

• Study Start (Actual): June 23, 2025
• Primary Completion (Estimated): December 23, 2025
• Study Completion (Estimated): January 15, 2026

Study Registration Dates

• First Submitted: June 5, 2025
• First Submitted That Met QC Criteria: June 17, 2025
• First Posted (Actual): June 26, 2025

Study Record Updates

• Last Update Posted (Actual): August 17, 2025
• Last Update Submitted That Met QC Criteria: August 15, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: Asthma; Asthma management; Computerized decision support system; Pharmacy
• Additional Relevant MeSH Terms: Immune System Diseases; Respiratory Tract Diseases; Lung Diseases; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Asthma
• Other Study ID Numbers: 46441

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No