Abstract
BackgroundAsthma is the most common chronic condition of childhood and disproportionately affects inner-city minority children. Low rates of asthma preventer medication adherence is a major contributor to poor asthma control in these patients. Web-based methods have potential to improve patient knowledge and medication adherence by providing interactive patient education, monitoring of symptoms and medication use, and by facilitation of communication and teamwork among patients and health care providers. Few studies have evaluated web-based asthma support environments using all of these potentially beneficial interventions. The multidimensional website created for this study, BostonBreathes, was designed to intervene on multiple levels, and was evaluated in a pilot trial.MethodsAn interactive, engaging website for children with asthma was developed to promote adherence to asthma medications, provide a platform for teamwork between caregivers and patients, and to provide primary care providers with up-to-date symptom information and data on medication use. Fifty-eight (58) children primarily from inner city Boston with persistent-level asthma were randomised to either usual care or use of BostonBreathes. Subjects completed asthma education activities, and reported their symptoms and medication use. Primary care providers used a separate interface to monitor their patients’ website use, their reported symptoms and medication use, and were able to communicate online via a discussion board with their patients and with an asthma specialist.ResultsAfter 6-months, reported wheezing improved significantly in both intervention and control groups, and there were significant improvements in the intervention group only in night-time awakening and parental loss of sleep, but there were no significant differences between intervention and control groups in these measures. Emergency room or acute visits to a physician for asthma did not significantly change in either group. Among the subgroup of subjects with low controller medication adherence at baseline, adherence improved significantly only in the intervention group. Knowledge of the purpose of controller medicine increased significantly in the intervention group, a statistically significant improvement over the control group.ConclusionsThis pilot study suggests that a multidimensional web-based educational, monitoring, and communication platform may have positive influences on pediatric patients’ asthma-related knowledge and use of asthma preventer medications.
Highlights
Asthma is the most common chronic condition of childhood and disproportionately affects inner-city minority children
A recent systematic review of digital interventions for asthma care concluded that digital interventions show promise [13], a recent meta-analysis raised questions about the strength of evidence behind the effectiveness of telemedicine interventions for asthma [21]
This paper describes the design, implementation, feasibility and potential effectiveness of a digital intervention for children with asthma, BostonBreathes (BB), which included multiple strategies for improving asthma outcomes
Summary
Asthma is the most common chronic condition of childhood and disproportionately affects inner-city minority children. Web-based methods have potential to improve patient knowledge and medication adherence by providing interactive patient education, monitoring of symptoms and medication use, and by facilitation of communication and teamwork among patients and health care providers. Key intervention components to improve asthma outcomes identified included provision of asthma information and self-care education, asthma action plans, self-monitoring, immediate feedback from devices, messages and alerts to patients, games and quizzes, and availability for daily use [13]. None of these studies included all listed potentially effective elements in their intervention design
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