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 Type
INTERVENTIONAL
Allocation
NA
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
25
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
St. Michael's Hospital, Unity Health Toronto
Toronto, Ontario, Canada
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
Time frame: 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
Time frame: During the 1 year intervention period
Implementation outcome - system satisfaction
satisfaction with/willingness to continue using the system (pharmacy team/patients), collected by questionnaire
Time frame: 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
Time frame: 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
Time frame: 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
Time frame: During the 1 year intervention period
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
Time frame: 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
Time frame: 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
Time frame: 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
Time frame: During the 1 year intervention period compared to the year prior
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