Mobile phone short messaging service for optimizing asthma treatment has no healthcare related effects: A controlled trial

Abstract

Context: One important aspect of modern asthma care is self-management: Allowing the patients to monitor their disease severity continuously and to adjust the dose of inhaled corticosteroid based on the symptoms, lung function, and the use of rescue medication. The Short Messaging Service (SMS) is a convenient, reliable, affordable, and secure means of telemedicine that may improve asthma control. Aim: The objective of this study is to assess the health-related effects of an SMS compliance and monitoring system for optimized asthma treatment. Settings and Design: In total, 244 asthmatics participated in a prospective controlled randomized trial (114 interventions, 130 controls). Materials and Methods: The intervention consisted of sequences of SMS messages sent to the intervention group, each containing two or three monitoring questions and one reminder to take the preventive medication. Both the intervention and control groups received questionnaires on days 0, 45, and 90. The primary outcome measures were a self-assessed outcome questionnaire that included a five question asthma control test, EQ-5D, use of health services, and questions on the use of preventive medicine. Statistical Analysis Used: The Pearson Chi-Square test was used for categorical variables (or Fisher's Exact Test, if the expected count was less than five in one or more cells) and the two-sample t-test or Wilcoxon Rank Sum test was used for continuous variables, as appropriate. The distributional assumption was investigated using histograms and P-P plots. Results: The use of SMS monitoring yielded no health-related effects, no decrease in the use of healthcare services, and no change in the use of medicine between the control and intervention groups. The lack of outcomes for the intervention was neither due to recruitment or the randomizing of participants nor due to dropouts. This study furthermore supports other findings concerning the lack of asthma control in the asthma population. Conclusion: Short Messaging Service is a reliable, convenient, affordable, secure, widespread, and a feasible technology for communication between the patient and healthcare system. However, even given the poor level of asthma control determined at the baseline, this study clearly documents that an SMS compliance and monitoring intervention design, like the one presented in this article, does not improve asthma control, nor does it generate fewer contacts with the healthcare system or improve the use of medicines.