iPads and action plans: a new approach to helping patients with asthma

Asthma is a chronic and potentially fatal disease affecting 8.3 per cent of Canadians aged 12 and over, with annual health care costs of more than $1.55 billion.

Even though asthma can be well controlled in most patients, the majority of cases remain poorly controlled.

Dr. Samir Gupta, a respirologist at St. Michael’s Hospital in Toronto, said he believes an innovative pilot project launched this month (July) can improve those outcomes.

Dr. Gupta’s study focuses on giving more patients asthma action plans, personalized guidelines for self-management of symptoms, through a waiting room iPad application.

“Previous studies have shown that action plans can significantly improve symptoms and quality of life and relieve patient dependency on the health care system,” said Dr. Gupta.  “For example, a patient using an action plan can expect less emergency room visits and better attendance at school or work.”

Kelly Pavelick, 47, has dealt with asthma her whole life.  She has had an asthma action plan  since she started seeing Dr. Gupta a few years ago and keeps it pinned up on her kitchen cupboard.

“An asthma attack can make you feel like you don’t have control,” said Pavelick.  “My asthma action plan gives me back a sense of control by helping me to manage and understand my symptoms.”

Even though asthma plans are effective, just 11 per cent of asthma patients have one.

“Unfortunately, most primary care physicians lack the time or the skills required to develop an action plan,” said Dr. Gupta. “Our project tackles both of those challenges. It puts the time piece on the patient and puts the knowledge piece into our decision support system.”

The application requires asthma patients to complete a simple touch questionnaire on an iPad in the physician’s waiting room.  It uses best evidence to determine whether a patient has acceptable asthma control or whether the patient requires any changes to medications, and produces a personalized asthma action plan.

The data is then sent to the clinician’s electronic medical system.  By the time the patient walks into the doctor’s office, the plan is ready. The physician can easily alter the plan if desired, save it to the patient’s chart and print for the patient.

“We’re hoping that we can see a significant increase in the rate at which patients are receiving asthma action plans,” said Dr. Gupta.  “We also want to see more patients learn to control their asthma – we will be measuring patient use of hospitals and emergency departments as a result of the study.”

The study is being conducted at two intervention sites in Hamilton and Brampton, the Hamilton Family Health Team and the Wise Elephant Family Health Team, and at two control sites in Mississauga and Toronto, the West Mississauga Clinic and the Kennedy Medical Clinic.

The electronic action plan application is already in use at the intervention sites.  The control sites will receive the new system next year.  For now, control site physicians have conventional paper-based action plan templates that they can fill out.

At the end of the one-year study period, results will be compared to see if the doctors using the electronic application prescribed more action plans than the doctors employing usual care.

If the study is successful, Dr. Gupta hopes to take the new application across the country – and perhaps in an even easier-to-use format. It could be made available as a free internet download for users through their smartphones.

Asthma is one of the many conditions treated at the St. Michael’s Respirology Clinic.  The clinic receives roughly 28,000 patient visits per year and has the largest and busiest pulmonary function lab in Toronto.  The clinic also has the largest Canadian clinic subspecialties for adult cystic fibrosis, Hereditary Hemorrhagic Telangiectasia, tuberculosis, and Hantavirus Pulmonary Syndrome.