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Almutairi M, Marriott JF, Mansur A. Effect of monitoring adherence to regular inhaled corticosteroid (ICS) alone or in combination with a long-acting β2-agonist (LABA) using electronic methods on asthma outcomes: a narrative systematic review. BMJ Open 2023; 13:e074127. [PMID: 37586865 PMCID: PMC10432637 DOI: 10.1136/bmjopen-2023-074127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES To evaluate through a systematic review the effectiveness of electronic methods in monitoring adherence to regular inhaled corticosteroids (ICS) alone or in combination with long-acting β2-agonists (LABAs) and their effect on clinical outcomes. DESIGN A narrative systematic review. DATA SOURCES MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and Web of Science were searched through up to 10 July 2022. ELIGIBILITY CRITERIA We included peer-reviewed studies of qualitative and quantitative outcomes that compared the effect of electronic methods to routine non-electronic monitoring intervention or placebo among children and adults with asthma on medication adherence rates to regular ICS alone or in combination with LABA, asthma control and asthma exacerbations. DATA EXTRACTION AND SYNTHESIS Data extraction was performed according to a predetermined sheet specific to the review objectives. The risk of bias was assessed using the Cochrane Risk of Bias Tool for randomised controlled trials and the Risk of Bias in Systematic Reviews tool for systematic reviews. Meta-analysis was not possible based on the findings of the scoping search; however, a narrative review was performed to allow for the grouping of results based on asthma inhaler adherence rates, asthma control and exacerbations. RESULTS Six articles comprising 98 studies published from 1998 to 2022 in the USA, Canada and the UK were included. Compared with the control, electronic monitoring devices (EMDs) showed a 23% adherence improvement, mean difference (MD) of 23%, 95% CI 10.84 to 34.16, p=0.0002. Asthmatic children were 1.5 times more likely to be adherent using EMDs compared with non-EMD users (RR=1.5, 95% CI 1.19 to 1.9) (p<0.001). Mobile devices and text message reminders (MHealth) showed a 12% adherence improvement (MD 12%, 95% CI 6.22 to 18.03) (p<0.0001), alongside a small to medium improvement in asthma control (standardised mean difference (SMD) 0.31, 95% CI 0.17 to 0.44), small improvement in asthma-related quality of life (SMD 0.26) (p=0.007) and variable risk reduction in asthma exacerbations for digital health (risk ratio 0.53, 95% CI 0.32 to 0.91) (p=0.02) compared with EMDs, which showed insignificant differences (risk ratio 0.89, 95% CI 0.45 to 1.75) (p=0.72). Technologies combined yielded variable adherence effects, with an SMD for eHealth of 0.41, 95% CI 0.02 to 0.79, and MD for digital health was 14.66% higher than the control, 95% CI 7.74 to 21.57. Heterogeneity between studies was significant (eHealth I2=98%, digital I2=94%). CONCLUSION Electronic methods improved adherence to inhaled medications in asthma. EMDs appear to be the most effective technology, followed by mHealth. The adherence improvement was associated with a small clinical improvement. There was inconsistent overlapping of terminology describing electronic methods that require standardisation. Data on the cost-effectiveness of electronic devices and their utilisation in severe asthma are lacking and require further research. PROSPERO REGISTRATION NUMBER CRD42022303069.
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Affiliation(s)
- Mohammed Almutairi
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Saudi Arabia
| | - John F Marriott
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Adel Mansur
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Harper LJ, Kidambi P, Kirincich JM, Thornton JD, Khatri SB, Culver DA. Health Disparities: Interventions for Pulmonary Disease - A Narrative Review. Chest 2023; 164:179-189. [PMID: 36858172 PMCID: PMC10329267 DOI: 10.1016/j.chest.2023.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023] Open
Abstract
There is expansive literature documenting the presence of health disparities, but there are disproportionately few studies describing interventions to reduce disparity. In this narrative review, we categorize interventions to reduce health disparity in pulmonary disease within the US health care system to support future initiatives to reduce disparity. We identified 211 articles describing interventions to reduce disparity in pulmonary disease related to race, income, or sex. We grouped the studies into the following four categories: biologic, educational, behavioral, and structural. We identified the following five main themes: (1) there were few interventional trials compared with the breadth of studies describing health disparities, and trials involving patients with asthma who were Black, low income, and living in an urban setting were overrepresented; (2) race or socioeconomic status was not an effective marker of individual pharmacologic treatment response; (3) telehealth enabled scaling of care, but more work is needed to understand how to leverage telehealth to improve outcomes in marginalized communities; (4) future interventions must explicitly target societal drivers of disparity, rather than focusing on individual behavior alone; and (5) individual interventions will only be maximally effective when specifically tailored to local needs. Much work has been done to catalog health disparities in pulmonary disease. Notable gaps in the identified literature include few interventional trials, the need for research in diseases outside of asthma, the need for high quality effectiveness trials, and an understanding of how to implement proven interventions balancing fidelity to the original protocol and the need to adapt to local barriers to care.
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Affiliation(s)
- Logan J Harper
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| | - Pranav Kidambi
- Michigan State University College of Human Medicine, Grand Rapids, MI; Division of Pulmonary and Critical Care Medicine, Corewell Health Medical Group, Grand Rapids, MI
| | - Jason M Kirincich
- Department of Internal Medicine, Community Care Institute, Cleveland Clinic, Cleveland, OH
| | - J Daryl Thornton
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH
| | - Sumita B Khatri
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
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Chan A, De Simoni A, Wileman V, Holliday L, Newby CJ, Chisari C, Ali S, Zhu N, Padakanti P, Pinprachanan V, Ting V, Griffiths CJ. Digital interventions to improve adherence to maintenance medication in asthma. Cochrane Database Syst Rev 2022; 6:CD013030. [PMID: 35691614 PMCID: PMC9188849 DOI: 10.1002/14651858.cd013030.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Asthma is the most common chronic lung condition worldwide, affecting 334 million adults and children globally. Despite the availability of effective treatment, such as inhaled corticosteroids (ICS), adherence to maintenance medication remains suboptimal. Poor ICS adherence leads to increased asthma symptoms, exacerbations, hospitalisations, and healthcare utilisation. Importantly, suboptimal use of asthma medication is a key contributor to asthma deaths. The impact of digital interventions on adherence and asthma outcomes is unknown. OBJECTIVES To determine the effectiveness of digital interventions for improving adherence to maintenance treatments in asthma. SEARCH METHODS We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted the most recent searches on 1 June 2020, with no restrictions on language of publication. A further search was run in October 2021, but studies were not fully incorporated. SELECTION CRITERIA We included randomised controlled trials (RCTs) including cluster- and quasi-randomised trials of any duration in any setting, comparing a digital adherence intervention with a non-digital adherence intervention or usual care. We included adults and children with a clinical diagnosis of asthma, receiving maintenance treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures for data collection. We used GRADE to assess quantitative outcomes where data were available. MAIN RESULTS We included 40 parallel randomised controlled trials (RCTs) involving adults and children with asthma (n = 15,207), of which eight are ongoing studies. Of the included studies, 30 contributed data to at least one meta-analysis. The total number of participants ranged from 18 to 8517 (median 339). Intervention length ranged from two to 104 weeks. Most studies (n = 29) reported adherence to maintenance medication as their primary outcome; other outcomes such as asthma control and quality of life were also commonly reported. Studies had low or unclear risk of selection bias but high risk of performance and detection biases due to inability to blind the participants, personnel, or outcome assessors. A quarter of the studies had high risk of attrition bias and selective outcome reporting. We examined the effect of digital interventions using meta-analysis for the following outcomes: adherence (16 studies); asthma control (16 studies); asthma exacerbations (six studies); unscheduled healthcare utilisation (four studies); lung function (seven studies); and quality of life (10 studies). Pooled results showed that patients receiving digital interventions may have increased adherence (mean difference of 14.66 percentage points, 95% confidence interval (CI) 7.74 to 21.57; low-certainty evidence); this is likely to be clinically significant in those with poor baseline medication adherence. Subgroup analysis by type of intervention was significant (P = 0.001), with better adherence shown with electronic monitoring devices (EMDs) (23 percentage points over control, 95% CI 10.84 to 34.16; seven studies), and with short message services (SMS) (12 percentage points over control, 95% CI 6.22 to 18.03; four studies). No significant subgroup differences were seen for interventions having an in-person component versus fully digital interventions, adherence feedback, one or multiple digital components to the intervention, or participant age. Digital interventions were likely to improve asthma control (standardised mean difference (SMD) 0.31 higher, 95% CI 0.17 to 0.44; moderate-certainty evidence) - a small but likely clinically significant effect. They may reduce asthma exacerbations (risk ratio 0.53, 95% CI 0.32 to 0.91; low-certainty evidence). Digital interventions may result in a slight change in unscheduled healthcare utilisation, although some studies reported no or a worsened effect. School or work absence data could not be included for meta-analysis due to the heterogeneity in reporting and the low number of studies. They may result in little or no difference in lung function (forced expiratory volume in one second (FEV1)): there was an improvement of 3.58% predicted FEV1, 95% CI 1.00% to 6.17%; moderate-certainty evidence); however, this is unlikely to be clinically significant as the FEV1 change is below 12%. Digital interventions likely increase quality of life (SMD 0.26 higher, 95% CI 0.07 to 0.45; moderate-certainty evidence); however, this is a small effect that may not be clinically significant. Acceptability data showed positive attitudes towards digital interventions. There were no data on cost-effectiveness or adverse events. Our confidence in the evidence was reduced by risk of bias and inconsistency. AUTHORS' CONCLUSIONS Overall, digital interventions may result in a large increase in adherence (low-certainty evidence). There is moderate-certainty evidence that digital adherence interventions likely improve asthma control to a degree that is clinically significant, and likely increase quality of life, but there is little or no improvement in lung function. The review found low-certainty evidence that digital interventions may reduce asthma exacerbations. Subgroup analyses show that EMDs may improve adherence by 23% and SMS interventions by 12%, and interventions with an in-person element and adherence feedback may have greater benefits for asthma control and adherence, respectively. Future studies should include percentage adherence as a routine outcome measure to enable comparison between studies and meta-analysis, and use validated questionnaires to assess adherence and outcomes.
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Affiliation(s)
- Amy Chan
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
- Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anna De Simoni
- Wolfson Institute of Population Health, Centre for Primary Care Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vari Wileman
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Lois Holliday
- Wolfson Institute of Population Health, Centre for Primary Care Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris J Newby
- Research Design Service, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Claudia Chisari
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Sana Ali
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Natalee Zhu
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | | | | | - Victoria Ting
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Chris J Griffiths
- Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Arenas J, Becker S, Seay H, Frisard C, Hoque S, Spano M, Lindenauer PK, Sadasivam RS, Pbert L, Trivedi M. A response to COVID-19 school closures: The feasibility of a school-linked text message intervention as an adaptation to school-supervised asthma therapy. Pediatr Pulmonol 2022; 57:1214-1222. [PMID: 35106970 PMCID: PMC9018493 DOI: 10.1002/ppul.25851] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/18/2022] [Accepted: 01/30/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND School-supervised asthma therapy improves asthma medication adherence and morbidity, particularly among low-income and underrepresented minority (URM) children. However, COVID-19-related school closures abruptly suspended this therapy. In response, we developed a school-linked text message intervention. OBJECTIVE The purpose of the study is to investigate the feasibility and acceptability of a school-linked text message intervention. METHODS In December 2020, children previously enrolled in school-supervised asthma therapy in Central Massachusetts were recruited into this school-linked text message intervention. We sent two-way, automated, daily text reminders in English or Spanish to caregivers of these children, asking if they had given their child their daily preventive asthma medicine. Our study team notified the school nurse if the caregiver did not consistently respond to text messages. School nurses performed weekly remote check-ins with all families. The primary outcome of the study was feasibility: recruitment, retention, and intervention fidelity. Secondarily we examined intervention acceptability and asthma health outcomes. RESULTS Twenty-six children (54% male, 69% Hispanic, 8% Black, 23% White, 93% Medicaid insured) and their caregivers were enrolled in the intervention with 96% participant retention at 6 months. Caregiver response rate to daily text messages was 81% over the study period. Children experienced significant improvements in asthma health outcomes. The intervention was well accepted by nurses and caregivers. CONCLUSION A school-linked text messaging intervention for pediatric asthma is feasible and acceptable. This simple, accessible intervention may improve health outcomes for low-income and URM children with asthma. It merits further study as a potential strategy to advance health equity.
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Affiliation(s)
- Juliana Arenas
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sarah Becker
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Hannah Seay
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christine Frisard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Shushmita Hoque
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Michelle Spano
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Peter K Lindenauer
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,Department of Healthcare Delivery and Population Science, Baystate Health, Springfield, MA, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Michelle Trivedi
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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5
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Baptist A, Gibson-Scipio W, Carcone AI, Ghosh S, Jacques-Tiura AJ, Hall A, MacDonell KK. Asthma and technology in emerging African American adults (The ATHENA Project): Protocol for a trial using the Multiphase Optimization Strategy framework (Preprint). JMIR Res Protoc 2022; 11:e37946. [PMID: 35536642 PMCID: PMC9131162 DOI: 10.2196/37946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Asthma causes substantial morbidity and mortality in the United States, particularly among African American emerging adults (AAEAs; aged 18-30 years), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be the most effective. However, intensive face-to-face interventions are often difficult to implement in this population. Objective The purpose of this study is to develop an effective mobile asthma management intervention to improve control among AAEAs. Methods We will assess the ability of multiple technologic components to assist and improve traditional asthma education. The first component is the Motivational Enhancement System for asthma management. It is a mobile 4-session intervention using supported self-regulation and motivational interviewing. Personalized content is based on each participant’s activity level, daily experiences, and goals. The second component is supportive accountability. It is administered by asthma nurses using targeted mobile support (Skype/voice calls) to provide education, promote self-efficacy, and overcome barriers through a motivational interviewing–based framework. The third component is SMS text messaging. It provides reminders for asthma education, medication adherence, and physical activity. The fourth component is physical activity tracking. It uses wearable technology to help meet user-defined physical activity goals. Using a multiphase optimization strategy (MOST) framework, we will test intervention components and combinations of components to identify the most effective mobile intervention. The MOST framework is an innovative, and cost- and time-effective framework that uses engineering principles to produce effective behavioral interventions. We will conduct a component selection experiment using a factorial research design to build an intervention that has been optimized for maximum efficacy, using a clinically significant improvement in asthma. Participants (N=180) will be randomized to 1 of 6 intervention arms. Participants will be recruited from multiple sites of the American Lung Association-Airway Clinical Research Centers network and ambulatory care clinics at the Detroit Medical Center. Data collections will occur at baseline, and 3, 6, and 12 months. Results At study completion, we will have an empirically supported optimized mobile asthma management intervention to improve asthma control for AAEAs. We hypothesize that postintervention (3, 6, and 12 months), participants with uncontrolled asthma will show a clinically significant improvement in asthma control. We also hypothesize that improvements in asthma management behaviors (including physical activity), quality of life, symptoms, adherence, and exacerbation (secondary outcomes) will be observed. Conclusions AAEAs are disproportionately impacted by asthma, but have been underrepresented in research. Mobile asthma management interventions may help improve asthma control and allow people to live healthier lives. During this project, we will use an innovative strategy to develop an optimized mobile asthma management intervention using the most effective combination of nurse-delivered asthma education, a smartphone app, and text messaging. International Registered Report Identifier (IRRID) PRR1-10.2196/37946
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Affiliation(s)
- Alan Baptist
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | | | - April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Samiran Ghosh
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Angela J Jacques-Tiura
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Amy Hall
- College of Nursing, Wayne State University, Detroit, MI, United States
| | - Karen Kolmodin MacDonell
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
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6
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Milne-Ives M, Lam C, Meinert E. Digital Technologies for Monitoring and Improving Treatment Adherence in Children and Adolescents With Asthma: Scoping Review of Randomized Controlled Trials. JMIR Pediatr Parent 2021; 4:e27999. [PMID: 34533463 PMCID: PMC8486994 DOI: 10.2196/27999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Inadequate pediatric asthma care has resulted in potentially avoidable unplanned hospital admissions and morbidity. A wide variety of digital technologies have been developed to monitor and support treatment adherence in children and adolescents with asthma. However, existing reviews need to be updated and expanded to provide an overview of the current state of research on these technologies and how they are being integrated into existing health care services and care pathways. OBJECTIVE This study aims to provide an overview of the current research landscape and knowledge gaps regarding the use of digital technologies to support the care of children and adolescents with asthma. METHODS This study was structured according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study frameworks. Five databases (PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Embase, and PsycINFO) were systematically searched for studies published in English from 2014 onward. Two reviewers independently screened the references and selected studies for inclusion based on the eligibility criteria. Data were systematically extracted per research question, which were synthesized in a descriptive analysis. RESULTS A wide variety of study characteristics, including the number and age of participants, study duration, and type of digital intervention, were identified. There was mixed evidence for the effectiveness of the interventions. Of the 10 studies that evaluated treatment adherence, 7 (70%) found improvements, but the evidence was inconsistent for asthma control (6/9, 67% of studies reported improvement or maintenance, but only 1 was significantly different between groups) and health outcome variables (5/9, 56% of studies found no evidence of effectiveness). The 6 studies that examined patient perceptions and assessments of acceptability and usability generally had positive findings. CONCLUSIONS A wide range of digital interventions are being developed and evaluated to support the monitoring and treatment adherence of children and adolescents with asthma. Meta-analyses are inhibited by the use of samples with a variety of overlapping age ranges; a theoretical framework for evaluating specific age groups would aid comparison between studies. Most studies found significant evidence for improved adherence to treatment or medications, but there was mixed evidence of the impact of the digital interventions on asthma control and other health outcomes. There are gaps in the literature relating to cost-effectiveness and integration with existing clinical care pathways. This study will be necessary to determine which digital interventions for children and young people with asthma are worth supporting and adopting in the clinical care pathways.
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Affiliation(s)
- Madison Milne-Ives
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Ching Lam
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Edward Meinert
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
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7
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Fidler A, Sweenie R, Ortega A, Cushing CC, Ramsey R, Fedele D. Meta-Analysis of Adherence Promotion Interventions in Pediatric Asthma. J Pediatr Psychol 2021; 46:1195-1212. [PMID: 34343294 DOI: 10.1093/jpepsy/jsab057] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Youth with asthma commonly have suboptimal adherence to inhaled corticosteroids (ICS). It is critical to systematically evaluate the effectiveness of ICS adherence promotion interventions and discern which techniques are most effective. OBJECTIVE This study aims to (1) quantify the extent to which interventions improve ICS adherence in pediatric asthma, (2) explore differences in effect size estimates based on intervention and study characteristics, and (3) characterize the risk of bias across interventions. METHODS We conducted literature searches across five databases. Included studies quantitatively measured ICS adherence as an intervention outcome among youth (<18 years old) diagnosed with asthma and were published after 1997. We analyzed aggregate effect sizes and moderator variables using random-effects models and characterized risk of bias using the Cochrane Collaboration tool. RESULTS Thirty-three unique studies met inclusion criteria. At post-intervention, the aggregate effect size for pediatric ICS adherence promotion interventions was small but significant (n = 33, g = 0.39, 95% confidence interval [CI] = 0.24-0.54); however, the aggregate effect size at follow-up was not statistically significant (n = 6, g = 0.38, 95% CI = -0.08 to 0.83). Method of adherence measurement and intervention format were significant moderators. Most interventions had a high risk of performance bias and an unclear risk of bias in one or more domains. CONCLUSIONS ICS adherence promotion interventions are effective among youth with asthma. Additional longitudinal research is needed to quantify a more precise measure of intervention effectiveness over time, and moderators of intervention effectiveness should be reassessed as the literature base expands.
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Affiliation(s)
- Andrea Fidler
- Department of Clinical & Health Psychology, University of Florida
| | - Rachel Sweenie
- Department of Clinical & Health Psychology, University of Florida
| | - Adrian Ortega
- Clinical Child Psychology Program and Schiefelbusch Institute for Life Span Studies, University of Kansas
| | - Christopher C Cushing
- Clinical Child Psychology Program and Schiefelbusch Institute for Life Span Studies, University of Kansas
| | - Rachelle Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - David Fedele
- Department of Clinical & Health Psychology, University of Florida
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Bruzzese JM, George M, Liu J, Evans D, Naar S, DeRosier ME, Thomas JM. The Development and Preliminary Impact of CAMP Air: A Web-based Asthma Intervention to Improve Asthma Among Adolescents. PATIENT EDUCATION AND COUNSELING 2021; 104:865-870. [PMID: 33004234 PMCID: PMC7956908 DOI: 10.1016/j.pec.2020.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Describe the development and preliminary impact of CAMP Air, a web-based intervention for adolescents with uncontrolled asthma. MATERIALS AND METHODS CAMP Air was developed using an iterative process with input from stakeholders and incorporating usability testing results (n = 14 adolescents). To test CAMP Air's initial impact, 61 adolescents from two New York City public high schools (n = 37) and from clinics, community-based organizations, and third-party recruitment services (i.e., community sample; n = 24) were enrolled in a randomized pilot trial. Participants were randomized to CAMP Air (n = 30) or information-and-referral control intervention (n = 31). A point-person worked with school participants to complete CAMP Air. RESULTS CAMP Air participants were satisfied with the intervention and its value for supporting self-management, completing on average 6 of 7 modules. Relative to controls, CAMP Air participants demonstrated significantly improved asthma knowledge, asthma control, night wakening and school absences, and less risk for urgent care visits. Adolescents enrolled in schools completed more modules and had significantly fewer nights woken and school absences than community enrollees. CONCLUSION CAMP Air improves asthma outcomes among adolescents with uncontrolled asthma. PRACTICE IMPLICATIONS A web-based intervention CAMP Air is a promising intervention. When a point-person works with adolescents, CAMP Air's access and impact are improved.
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Affiliation(s)
| | | | - Jianfang Liu
- Columbia University School of Nursing, United States
| | - David Evans
- Columbia University Mailman School of Public Health, United States
| | - Sylvie Naar
- Florida State University, Center for Translational Behavioral Science, United States
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9
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Mosnaim G, Safioti G, Brown R, DePietro M, Szefler SJ, Lang DM, Portnoy JM, Bukstein DA, Bacharier LB, Merchant RK. Digital Health Technology in Asthma: A Comprehensive Scoping Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2377-2398. [PMID: 33652136 DOI: 10.1016/j.jaip.2021.02.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND A variety of digital intervention approaches have been investigated for asthma therapy during the past decade, with different levels of interactivity and personalization and a range of impacts on different outcome measurements. OBJECTIVE To assess the effectiveness of digital interventions in asthma with regard to acceptability and outcomes and evaluate the potential of digital initiatives for monitoring or treating patients with asthma. METHODS We evaluated digital interventions using a scoping review methodology through a literature search and review. Of 871 articles identified, 121 were evaluated to explore intervention characteristics, the perception and acceptability of digital interventions to patients and physicians, and effects on asthma outcomes. Interventions were categorized by their level of interactivity with the patient. RESULTS Interventions featuring non-individualized content sent to patients appeared capable of promoting improved adherence to inhaled corticosteroids, but with no identified improvement in asthma burden; and data-gathering interventions appeared to have little effect on adherence or asthma burden. Evidence of improvement in both adherence and patients' impairment due to asthma were seen only with interactive interventions involving two-way responsive patient communication. Digital interventions were generally positively perceived by patients and physicians. Implementation was considered feasible, with certain preferences for design and features important to drive use. CONCLUSIONS Digital health interventions show substantial promise for asthma disease monitoring and personalization of treatment. To be successful, future interventions will need to include both inhaler device and software elements, combining accurate measurement of clinical parameters with careful consideration of ease of use, personalization, and patient engagement aspects.
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Affiliation(s)
- Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, North Shore University Health System, Evanston, Ill
| | | | - Randall Brown
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa
| | - Michael DePietro
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa.
| | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jay M Portnoy
- Pediatric Allergy and Immunology, Children's Mercy Hospital, Kansas City School of Medicine, Kansas City, Mo
| | - Don A Bukstein
- Allergy, Asthma and Sinus Center, Milwaukee, Greenfield, Wis
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | - Rajan K Merchant
- Woodland Clinic Medical Group, Allergy Department, Dignity Health, Woodland, Calif
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10
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Ferrante G, Licari A, Marseglia GL, La Grutta S. Digital health interventions in children with asthma. Clin Exp Allergy 2020; 51:212-220. [PMID: 33238032 PMCID: PMC7753570 DOI: 10.1111/cea.13793] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/13/2020] [Accepted: 11/22/2020] [Indexed: 12/20/2022]
Abstract
Although healthcare providers are actively involved in offering education, information and interventions for asthmatic patients, medication and therapeutic adherence remain low in the paediatric population, with estimates suggesting that adherence rates hover below 50%. A range of available digital health interventions has been explored in paediatric asthma with promising but variable results, limiting their widespread adoption in clinical practice. They include emerging technologies that yield the advantage of tracking asthma symptoms and medications, setting drug reminders, improving inhaler technique and delivering asthma education, such as serious games (video games designed for medical‐ or health‐related purposes), electronic monitoring devices, speech recognition calls, text messaging, mobile apps and interactive websites. Some of the proposed digital interventions have used multiple components, including educational and behavioural strategies and interactions with medical professionals. Overall, the implementation of such interventions may offer the opportunity to improve adherence and asthma control. In a state of emergency as the COVID‐19 pandemic, telemedicine can also play a central role in supporting physicians in managing children with asthma. This review evaluates the published literature examining digital health interventions for paediatric asthma and explores the most relevant issues affecting their implementation in practice and the associated evidence gaps, research limitations and future research perspectives.
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Affiliation(s)
- Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania La Grutta
- Institute for Research and Biomedical Innovation (IRIB), National Research Council (CNR), Palermo, Italy
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11
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Blower S, Swallow V, Maturana C, Stones S, Phillips R, Dimitri P, Marshman Z, Knapp P, Dean A, Higgins S, Kellar I, Curtis P, Mills N, Martin-Kerry J. Children and young people's concerns and needs relating to their use of health technology to self-manage long-term conditions: a scoping review. Arch Dis Child 2020; 105:1093-1104. [PMID: 32444448 PMCID: PMC7588410 DOI: 10.1136/archdischild-2020-319103] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of patient-facing health technologies to manage long-term conditions is increasing; however, children and young people may have particular concerns or needs before deciding to use different health technologies. AIMS To identify children and young people's reported concerns or needs in relation to using health technologies to self-manage long-term conditions. METHODS A scoping review was conducted. We searched MEDLINE, PsycINFO and CINAHL in February 2019. Searches were limited to papers published between January 2008 and February 2019. We included any health technology used to manage long-term conditions. A thematic synthesis of the data from the included studies was undertaken. We engaged children with long-term conditions (and parents) to support review design, interpretation of findings and development of recommendations. RESULTS Thirty-eight journal articles were included, describing concerns or needs expressed by n=970 children and/or young people aged 5-18 years. Most included studies were undertaken in high-income countries with children aged 11 years and older. Studies examined concerns with mobile applications (n=14), internet (n=9), social media (n=3), interactive online treatment programmes (n=3), telehealth (n=1), devices (n=3) or a combination (n=5). Children and young people's main concerns were labelling and identity; accessibility; privacy and reliability; and trustworthiness of information. DISCUSSION This review highlights important concerns that children and young people may have before using technology to self-manage their long-term condition. In future, research should involve children and young people throughout the development of technology, from identifying their unmet needs through to design and evaluation of interventions.
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Affiliation(s)
- Sarah Blower
- Department of Health Sciences, University of York, York, UK
| | - Veronica Swallow
- College of Health, Wellbeing & Life Sciences, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | - Camila Maturana
- York Trials Unit, University of York, York, North Yorkshire, UK
| | - Simon Stones
- School of Healthcare, University of Leeds, Leeds, West Yorkshire, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
| | - Paul Dimitri
- NIHR Children and Young People MedTech Cooperative, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, Sheffield, UK
| | - Zoe Marshman
- School of Clinical Dentistry, The University of Sheffield, Sheffield, Sheffield, UK
| | - Peter Knapp
- Department of Health Sciences and Hull York Medical School, University of York, York, North Yorkshire, UK
| | - Alexandra Dean
- York Trials Unit, University of York, York, North Yorkshire, UK
| | | | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, West Yorkshire, UK
| | - Penny Curtis
- School of Nursing and Midwifery, The University of Sheffield, Sheffield, Sheffield, UK
| | - Nathaniel Mills
- NIHR Children and Young People MedTech Co-operative and NIHR Devices for Dignity MedTech Co-operative, Sheffield Children's NHS Trust, Sheffield, UK
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12
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Badawy SM, Shah R, Beg U, Heneghan MB. Habit Strength, Medication Adherence, and Habit-Based Mobile Health Interventions Across Chronic Medical Conditions: Systematic Review. J Med Internet Res 2020; 22:e17883. [PMID: 32343250 PMCID: PMC7218590 DOI: 10.2196/17883] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/02/2020] [Accepted: 03/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Unintentional medication nonadherence is common and has been associated with poor health outcomes and increased health care costs. Earlier research demonstrated a relationship between habit strength and medication adherence. Previous research also examined a habit's direct effect on adherence and how habit interacts with more conscious factors to influence or overrule them. However, the relationship between habit and adherence and the role of habit-based mobile health (mHealth) interventions remain unclear. OBJECTIVE This review aimed to systematically evaluate the most recent evidence for habit strength, medication adherence, and habit-based mHealth interventions across chronic medical conditions. METHODS A keyword search with combinations of the terms habit, habit strength, habit index, medication adherence, and medication compliance was conducted on the PubMed database. After duplicates were removed, two authors conducted independent abstract and full-text screening. The guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed when reporting evidence across the included and reviewed studies. RESULTS Of the 687 records examined, 11 met the predefined inclusion criteria and were finalized for data extraction, grading, and synthesis. Most included studies (6/11, 55%) were cross-sectional and used a theoretical model (8/11, 73%). The majority of studies measured habit strength using the self-report habit index and self-report behavioral automaticity index (9/11, 82%). Habit strength was positively correlated with medication adherence in most studies (10/11, 91%). Habit mediated the effects of self-efficacy on medication adherence (1/11, 9%), and social norms moderated the effects of habit strength on medication adherence (1/11, 9%). Habit strength also moderated the effects of poor mental health symptoms and medication adherence (1/11, 9%). None of the included studies reported on using or proposing a habit-based mHealth behavioral intervention to promote medication adherence. CONCLUSIONS Habit strength was strongly correlated with medication adherence, and stronger habit was associated with higher medication adherence rates, regardless of the theoretical model and/or guiding framework. Habit-based interventions should be used to increase medication adherence, and these interventions could leverage widely available mobile technology tools such as mobile apps or text messaging, and existing routines.
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Affiliation(s)
- Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Richa Shah
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States
| | - Usman Beg
- Midwestern University Arizona College of Osteopathic Medicine, Glendale, AZ, United States
| | - Mallorie B Heneghan
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
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13
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Ramsey RR, Plevinsky JM, Kollin SR, Gibler RC, Guilbert TW, Hommel KA. Systematic Review of Digital Interventions for Pediatric Asthma Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:1284-1293. [PMID: 31870809 PMCID: PMC7152564 DOI: 10.1016/j.jaip.2019.12.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/06/2019] [Accepted: 12/05/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Pediatric patients with asthma take only approximately half of their prescribed medication. Digital interventions to improve adherence for youth with asthma exist and have the potential to improve accessibility, cost-effectiveness, and customizability. OBJECTIVE To systematically review published research examining digital interventions to promote adherence to the treatment of pediatric asthma. METHODS A systematic search of the PubMed, Scopus, CINAHL, PsycINFO, and reference review databases was conducted. Articles were included if adherence was an outcome in a randomized controlled trial of a digital intervention for children with asthma. We compared samples, intervention characteristics, adherence measurement and outcomes, as well as additional health outcomes across studies. RESULTS Of the 264 articles reviewed, 15 studies met inclusion criteria and were included in the review. Overall, 87% of the digital interventions demonstrated improved adherence and 53% demonstrated improved health outcomes. All the promising interventions included a behavioral component and most were 3 to 6 months in length, delivered through a digital stand-alone medium (eg, automated personalized texts, mobile health apps, and website), and assessed adherence to controller medication. CONCLUSIONS Overall, digital interventions aimed at improving adherence are promising and also improve health outcomes in addition to medication adherence. Although future studies using evidence-based adherence assessment and multifactorial design should be conducted, the current literature suggests that both digital stand-alone interventions and interventions combining digital technology with support from a health care team member result in improved adherence and asthma outcomes. Recommendations for digital interventions for pediatric patients with asthma with adherence concerns are provided.
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Affiliation(s)
- Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Jill M Plevinsky
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sophie R Kollin
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robert C Gibler
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio
| | - Theresa W Guilbert
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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14
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Murphy J, McSharry J, Hynes L, Matthews S, Van Rhoon L, Molloy GJ. Prevalence and predictors of adherence to inhaled corticosteroids in young adults (15-30 years) with asthma: a systematic review and meta-analysis. J Asthma 2020; 58:683-705. [PMID: 31906744 DOI: 10.1080/02770903.2020.1711916] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: Adherence to inhaled corticosteroids (ICS) is an essential part of asthma management throughout the lifespan; however, this may be particularly challenging during the transition into adulthood. This systematic review aimed to determine the prevalence and predictors of adherence to ICS in emerging adulthood.Data sources: MEDLINE, PsycINFO, EMBASE, Scopus, and CINAHL were searched with search terms for asthma, ICS, adherence, young adults, and predictors combined.Study selection: Studies with participants with diagnosed asthma, currently prescribed ICS, a mean age between 15 and 30 years and reporting the prevalence and/or assessing predictor(s) of adherence using quantitative methods were included.Results: Twenty-nine studies were identified for inclusion (K = 29, N = 187 401). A random effect meta-analysis revealed the pooled prevalence of adherence was 28% (95% CI = 20-38%, k = 16) in studies that provided quantitative information on adherence. Adherence was higher in studies with a mean age <18 years (36%; 95% CI = 36-37%, k = 4). Studies using self-report measures provided higher estimates of adherence (35%; 95% CI = 28-42%, k = 10) than studies using pharmacy refill data (20%; 95% CI = 9-38%, k = 6). A narrative review identified personality, illness perceptions, and treatment beliefs as potentially important predictors of adherence.Conclusion: Adherence is sub-optimal during emerging adulthood, particularly after age 18. More reliable and objective measures are needed to precisely characterize adherence. Greater research and practice attention to emerging adulthood are needed to guide self-management support in those living with asthma at this important lifespan stage.Systematic review registration number: CRD42018092401.
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Affiliation(s)
- Jane Murphy
- School of Psychology, NUI Galway, Galway, Ireland
| | | | - Lisa Hynes
- School of Medicine, NUI Galway, Galway, Ireland
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15
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Hashi S, Tsukasaki K, Nakamura T, Kyota K, Itatani T. Effects of maintaining web-based diaries by caregivers on adherence to care regimens in preschoolers with asthma. J SPEC PEDIATR NURS 2019; 24:e12263. [PMID: 31332967 DOI: 10.1111/jspn.12263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The objective of this pilot study was to assess the effects of maintaining web-based diaries by the caregivers of preschoolers with asthma on the adherence to asthma care regimens, the recognition of asthma symptoms, and their perceived levels of parenting stress, quality of life, and family functioning. DESIGN AND METHODS The caregivers of preschoolers with asthma completed a 4-week web-based diary and received weekly emails that depicted their children's asthma symptoms. We compared asthma symptoms from before and after the intervention. We analyzed demographic data, such as the caregivers' age and education, and assessment scores from the Japanese Pediatric Asthma Control program (JPAC), Adherence with Asthma Management for Caregivers of Preschoolers (AAMCP), General Functioning subscale of the Family Assessment Device (GF-FAD), Parenting Stress Index Short Form (PSI-SF), and Quality of Life assessment scale for Caregivers of Asthmatic Children 24 (QOLCA-24). RESULTS A total of 45 participants were included in the analyses. The mean scores depicting asthma control were significantly improved postintervention (pre: 12.29 ± 2.65; post: 13.02 ± 2.01; t = -2.15, p = .037). Mean AAMCP scores postintervention (52.13 ± 6.25) were significantly greater than before (49.78 ± 7.20; t = -3.07; p = .004). PRACTICE IMPLICATIONS Adherence to asthma care and the recognition of asthma symptoms improved following the use of a web-based diary, making it a potential cost-effective intervention for asthma patients and their families.
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Affiliation(s)
- Shinobu Hashi
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.,School of Nursing, Kanazawa Medical University, Kanazawa, Japan
| | - Keiko Tsukasaki
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Toshimi Nakamura
- Department of Pediatrics, Kanazawa Medical University, Kanazawa, Japan
| | - Kaoru Kyota
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Tomoya Itatani
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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16
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Abstract
Severe asthma accounts for only a small proportion of the children with asthma but a disproportionately high amount of resource utilization and morbidity. It is a heterogeneous entity and requires a step-wise, evidence-based approach to evaluation and management by pediatric subspecialists. The first step is to confirm the diagnosis by eliciting confirmatory history and objective evidence of asthma and excluding possible masquerading diagnoses. The next step is to differentiate difficult-to-treat asthma, asthma that can be controlled with appropriate management, from asthma that requires the highest level of therapy to maintain control or remains uncontrolled despite management optimization. Evaluation of difficult-to-treat asthma includes an assessment of medication delivery, the home environment, and, if possible, the school and other frequented locations, the psychosocial situation, and comorbid conditions. Once identified, aggressive management of issues related to poor adherence and drug delivery, remediation of environmental triggers, and treatment of comorbid conditions is necessary to characterize the degree of control that can be achieved with standard therapies. For the small proportion of patients whose disease remains poorly controlled with these interventions, the clinician may assess steroid responsiveness and determine the inflammatory pattern and eligibility for biologic therapies. Management of severe asthma refractory to traditional therapies involves considering the various biologic and other newly approved treatments as well as emerging therapies based on the individual patient characteristics.
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17
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Sample D, Turner J. Improving gluten free diet adherence by youth with celiac disease. Int J Adolesc Med Health 2019; 33:/j/ijamh.ahead-of-print/ijamh-2019-0026/ijamh-2019-0026.xml. [PMID: 30875325 DOI: 10.1515/ijamh-2019-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/17/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Celiac disease (CD) is a gluten-triggered autoimmune disorder of the small intestine, which can occur in genetically susceptible individuals at any age. A strict life-long gluten free diet (GFD) is the only medically approved treatment, and non-adherence is associated with significant morbidity. However, gluten use is widespread, complicating efforts to follow the diet. Youth with CD are especially challenged with dietary adherence, as they strive for peer acceptance and personal autonomy in the context of managing a chronic disease. METHODS A scoping review was conducted to identify mechanisms to assist youth with remaining gluten free. RESULTS There is a paucity of literature regarding best approaches to improve diet adherence by youth, however, lessons can also be learned by borrowing ideas from self-management approaches of other chronic diseases. Several mechanisms for improving GFD adherence among youth are identified, including regular engagement of the youth with CD and their family with an experienced multidisciplinary team, electronic tool utilization and awareness of accurate resources for self-guided education and resources. CONCLUSIONS Improvement in GFD adherence by youth is achievable and may influence long-term health outcomes.
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Affiliation(s)
- Dory Sample
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada, Phone: +780-248-5599
| | - Justine Turner
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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18
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Bittner B, Schmit Chiesi C, Kharawala S, Kaur G, Schmidt J. Connected drug delivery devices to complement drug treatments: potential to facilitate disease management in home setting. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:101-127. [PMID: 30881151 PMCID: PMC6419593 DOI: 10.2147/mder.s198943] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Connected drug delivery devices are increasingly being developed to support patient supervision and counseling in home setting. Features may include dosing reminders, adherence trackers, tools for patient education, and patient diaries to collect patient-reported outcomes, as well as monitoring tools with interfaces between patients and health care professionals (HCPs). Five connected devices have been selected as the basis for a review of the clinical evidence concerning the impact of electronic tools on treatment adherence and efficacy outcomes. Disease areas covered include multiple sclerosis, diabetes, hypertension, liver and renal transplant recipients, tuberculosis, hepatitis C, clinically isolated syndrome, asthma, and COPD. From studies comparing the use of electronic feedback tools to standard of care, there is an initial evidence for a higher adherence to treatment and better outcomes among patients who use the electronic tools. To substantiate the assumption that connected devices can improve adherence in an outpatient setting over a prolonged period of time, further data from controlled randomized studies are required. Key barriers to the broader adoption of connected devices include data privacy laws that may prevent data sharing with HCPs in some countries, as well as the need to demonstrate that the tools are consistently used and generate a high-quality and reproducible database. If these challenges can be addressed in a way that is agreeable to all stakeholders, it is expected that the future value of connected devices will be to 1) facilitate and improve patient involvement in disease management in a flexible care setting, 2) enable early treatment decisions, and 3) complement value-based reimbursement models.
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Affiliation(s)
- Beate Bittner
- Product Optimization, Global Product Strategy, F. Hoffmann-La Roche Ltd, 4070 Basel, Switzerland,
| | - Chantal Schmit Chiesi
- Product Optimization, Global Product Strategy, F. Hoffmann-La Roche Ltd, 4070 Basel, Switzerland,
| | | | - Gavneet Kaur
- Bridge Medical Consulting Ltd, Richmond, London, TW9 2SS, UK
| | - Johannes Schmidt
- Product Optimization, Global Product Strategy, F. Hoffmann-La Roche Ltd, 4070 Basel, Switzerland,
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19
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Liu LH, Fevrier HB, Goldfien R, Hemmerling A, Herrinton LJ. Understanding Nonadherence with Hydroxychloroquine Therapy in Systemic Lupus Erythematosus. J Rheumatol 2019; 46:1309-1315. [DOI: 10.3899/jrheum.180946] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2019] [Indexed: 01/06/2023]
Abstract
Objective.Hydroxychloroquine (HCQ) is a cornerstone to managing systemic lupus erythematosus (SLE), yet adherence to medication is poor. We sought to measure the association of adherence with 5 “dimensions of adherence” as articulated by the World Health Organization for chronic conditions: the patient’s socioeconomic status, and patient-, condition-, therapy-, and healthcare system–related factors. Our longterm goal is to generate evidence to design effective interventions to increase adherence.Methods.The retrospective cohort study included Kaiser Permanente Northern California patients ≥ 18 years old during 2006–2014, with SLE and ≥ 2 consecutive prescriptions for HCQ. Adherence was calculated from the medication possession ratio and dichotomized as < 80% versus ≥ 80%. Predictor variables were obtained from the electronic medical record and census data. We used multivariable logistic regression to estimate adjusted OR and 95% CI.Results.The study included 1956 patients. Only 58% of patients had adherence ≥ 80%. In adjusted analyses, socioeconomic variables did not predict adherence. Increasing age (65–89 yrs compared with ≤ 39 yrs: OR 1.44, 95% CI 1.07–1.93), white race (p < 0.05), and the number of rheumatology visits in the year before baseline (≥ 3 compared with 0 or 1: OR 1.47, 95% CI 1.18–1.83) were positively associated with adherence. The rheumatologist and medical center providing care were not associated with adherence.Conclusion.At our setting, as in other settings, about half of patients with SLE were not adherent to HCQ therapy. Differences in adherence by race/ethnicity suggest the possibility of using tailored interventions to increase adherence. Qualitative research is needed to elucidate patient preferences for adherence support.
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20
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Blakey JD, Bender BG, Dima AL, Weinman J, Safioti G, Costello RW. Digital technologies and adherence in respiratory diseases: the road ahead. Eur Respir J 2018; 52:1801147. [PMID: 30409819 PMCID: PMC6364097 DOI: 10.1183/13993003.01147-2018] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/25/2018] [Indexed: 01/09/2023]
Abstract
Outcomes for patients with chronic respiratory diseases remain poor despite the development of novel therapies. In part, this reflects the fact that adherence to therapy is low and clinicians lack accurate methods to assess this issue. Digital technologies hold promise to overcome these barriers to care. For example, algorithmic analysis of large amounts of information collected on health status and treatment use, along with other disease relevant information such as environmental data, can be used to help guide personalised interventions that may have a positive health impact, such as establishing habitual and correct inhaler use. Novel approaches to data analysis also offer the possibility of statistical algorithms that are better able to predict exacerbations, thereby creating opportunities for preventive interventions that may adapt therapy as disease activity changes. To realise these possibilities, digital approaches to disease management should be supported by strong evidence, have a solid infrastructure, be designed collaboratively as clinically effective and cost-effective systems, and reflect the needs of patients and healthcare providers. Regulatory standards for digital interventions and strategies to handle the large amounts of data generated are also needed. This review highlights the opportunities provided by digital technologies for managing patients with respiratory diseases.
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Affiliation(s)
- John D Blakey
- Respiratory Medicine, Royal Liverpool Hospital and Health Services Research, University of Liverpool, Liverpool, UK
| | - Bruce G Bender
- Dept of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Alexandra L Dima
- Health Services and Performance Research, Université Claude Bernard Lyon 1, Lyon, France
| | - John Weinman
- Institute of Pharmaceutical Science and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Richard W Costello
- RCSI Education and Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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21
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Smartphone Applications for Encouraging Asthma Self-Management in Adolescents: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112403. [PMID: 30380692 PMCID: PMC6266660 DOI: 10.3390/ijerph15112403] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/24/2018] [Indexed: 12/05/2022]
Abstract
Adolescent asthma is still a major problem with poor adherence to treatment. Globally, adolescents are devoted users of smartphone technologies and app use in asthma self-management may improve adherence. The objective of this systematic review is to assess the feasibility and efficacy of mobile technology in improving asthma outcomes in adolescents. We conducted an extensive review of the peer-review literature of studies with populations consisting of children and adolescents under 18 years in seven bibliographic databases and Google Scholar. All study designs were considered. Quality assessment of included studies were independently assessed and reported. The search identified 291 articles; of the 16 eligible full-text papers, 8 met the review criteria, reporting two interventional, two qualitative and four observational studies. Samples ranged from 12 to 21 participants. Heterogeneity related to study design and the methods of the included studies prevented meta-analysis. Nevertheless, the intervention studies reported a positive effect of smartphone apps on asthma control, medication adherence and self-efficacy. Smartphone apps may be an effective asthma control tool especially among adolescents who are major users of smartphones; however, conclusions are limited by a lack of controlled trials and adequate sample sizes.
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Direct-to-adolescent text messaging for vaccine reminders: What will parents permit? Vaccine 2018; 36:2788-2793. [PMID: 29653849 DOI: 10.1016/j.vaccine.2018.03.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 02/19/2018] [Accepted: 03/31/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Direct-to-adolescent text messaging may be a consideration for vaccine reminders, including human papilloma virus (HPV), but no studies have explored the minimum age at which parents would allow adolescents to receive a text message. METHODS We distributed a survey to parents of 10-17 year olds during any office visit in two practice based research networks in South Carolina and Oklahoma. We asked about parental preference for receiving vaccine reminders for their adolescent, whether they would allow the healthcare provider to directly message their adolescent, and if so, what would be the acceptable minimum age. RESULTS In 546 surveys from 11 practices, parents of females were more supportive of direct-to-teen text message reminders than were parents of males, (75% v. 60%, p < .001). The median age at which parents would allow direct text messages from physicians' offices was 14 in females compared to 15 in males, p = .049. We found a correlation between the child's age and the youngest age at which parents would allow a direct text message. Of the parents who permitted a text message directly to their adolescent, most reported an allowable age higher than their adolescent's current age until the age of 15. CONCLUSION Our study suggests that direct-to-adolescent text messaging would be allowed by parents for older adolescents. This supports an intervention aimed at older adolescents, such as for receipt of MCV4 dose #2, delayed HPV vaccine series completion and annual influenza vaccination.
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Dodds CM, Britto MT. Learnings from a pragmatic pilot trial of text messaging for high-risk adolescents with asthma. Ann Allergy Asthma Immunol 2018; 120:546-547. [PMID: 29432968 DOI: 10.1016/j.anai.2018.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/10/2018] [Accepted: 02/02/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Cassandra M Dodds
- Center for Innovation in Chronic Disease Care, Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Maria T Britto
- Center for Innovation in Chronic Disease Care, Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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