Impact of an EHR-based tool on COPD Management in Primary Care

Background: GOLD (2017) guidelines provide evidence based recommendations for treating COPD, although their employment in clinical practice is inconsistent. Lack of a standardized method to view COPD specific information within the EHR during patient encounters complicates visits and development of GOLD-guided treatment plans. Our goal is to determine the impact of an EHR-based tool on relevant COPD disease measurements (spirometry rates, pneumococcal vaccination rates and COPD Action plans) Methods: An EHR-based tool (SmartPhrase) was developed and released to providers to facilitate GOLD(2017) guideline reference during patient encounters. Computer based instructional videos of GOLD (2017) guidelines and EHR-based tool were presented to providers prior to 90 day intervention. A two-pronged pre-and post-intervention analysis was carried out examining 1) subjective provider application of GOLD (2017) guidelines, and 2) objective inclusion of GOLD guidelines within the EHR patient encounter of COPD patients aged \u3e 18 at a rural Primary Care clinic. Results: Compared to pre-intervention, providers reported EHR-tool was rated as ‘likely’ to improve job performance and effectiveness when treating COPD patients (from 42.8% to 75%) and ‘likely’ to make documenting COPD-specific data easier (28.5% to 75%), increased tendency to order Spirometry (33.9%) and refer to Pulmonary Rehab more frequently (25%). Compared to pre-intervention, objective changes in spirometry rates increased 3.9%, vaccination rates for PCV13 and PPSV23 increased slightly (both 1.9%); there were no changes in number of COPD Action plans. Conclusions: Preliminary data suggests that an EHR-based tool is a potentially effective tool to increase awareness and application of GOLD guidelines in the treatment of COPD in Primary Care. Increased intervention period of 12 months may provide more insight into changes in treatment practices

Education Program using Non-Pharmacologic Support during Benzodiazepine Reduction in Patients with Anxiety Disorders

A private mental health clinic developed an initiative to aid patients with anxiety disorders to taper their use of benzodiazepines. Based on best practices, a treatment protocol was developed in which patients attended 4 sessions (1 per month) in which they combined instruction in non-pharmaceutical anti-anxiety techniques (guided imagery, mindfulness meditation, deep breathing, progressive muscle relaxation, exercise, emotional freedom) with cognitive behavioral therapy and use of selective serotonin re uptake inhibitors. Participants experienced a reduction in benzodiazepine use. This small scale initiative showed that the holistic approach to anxiety management was an effective plan to decrease the use of benzodiazepines in the treatment of anxiety disorder