eHealth is an appealing medium to improve healthcare and its value (in addition to standard care) has been assessed in previous studies. We aimed to assess whether an eHealth intervention could improve asthma control while reducing 50% of routine outpatient visits.In a multicentre, randomised controlled trial with a 16-month follow-up, asthmatic children (6-16 years) treated in eight Dutch hospitals were randomised to usual care (4-monthly outpatient visits) and online care using a virtual asthma clinic (VAC) (8-monthly outpatient visits with monthly web-based monitoring). Outcome measures were the number of symptom-free days in the last 4 weeks of the study, asthma control, forced expiratory volume in 1 s, exhaled nitric oxide fraction, asthma exacerbations, unscheduled outpatient visits, hospital admissions, daily dose of inhaled corticosteroids and courses of systemic corticosteroids.We included 210 children. After follow-up, symptom-free days differed statistically between the usual care and VAC groups (difference of 1.23 days, 95% CI 0.42-2.04; p=0.003) in favour of the VAC. In terms of asthma control, the Childhood Asthma Control Test improved more in the VAC group (difference of 1.17 points, 95% CI 0.09-2.25; p=0.03). No differences were found for other outcome measures.Routine outpatient visits can partly be replaced by monitoring asthmatic children eHealth.

BackgroundDespite their potential benefits, many electronic health (eHealth) innovations evaluated in major studies fail to integrate into organizational routines, and the implementation of these innovations remains problematic.ObjectiveThe purpose of this study was to describe health care professionals’ self-identified perceived barriers and facilitators for the implementation of a Web-based portal to monitor asthmatic children as a substitution for routine outpatient care. Also, we assessed patients’ (or their parents) satisfaction with this eHealth innovation.MethodsBetween April and November 2015, we recruited 76 health care professionals (from 14 hospitals). During a period of 6 months, participants received 3 questionnaires to identify factors that facilitated or impeded the use of this eHealth innovation. Questionnaires for patients (or parents) were completed after the 6-month virtual asthma clinic (VAC) implementation period.ResultsMajor perceived barriers included concerns about the lack of structural financial reimbursement for Web-based monitoring, lack of integration of this eHealth innovation with electronic medical records, the burden of Web-based portal use on clinician workload, and altered patient-professional relationship (due to fewer face-to-face contacts). Major perceived facilitators included enthusiastic and active initiators, a positive attitude of professionals toward eHealth, the possibility to tailor care to individual patients (“personalized eHealth”), easily deliverable care according to current guidelines using the VAC, and long-term profit and efficiency.ConclusionsThe implementation of Web-based disease monitoring and management in children is complex and dynamic and is influenced by multiple factors at the levels of the innovation itself, individual professionals, patients, social context, organizational context, and economic and political context. Understanding and defining the barriers and facilitators that influence the context is crucial for the successful implementation and sustainability of eHealth innovations.

To the Editor: eHealth interventions have been proposed as an appealing method to improve health outcomes and reduce healthcare costs [1][2][3]. However, the development of an eHealth intervention is associated with high costs and this investment needs to be balanced by increased clinical effectiveness and related cost savings. Unfortunately, solid evidence for the effectiveness of eHealth with regard to health improvement is still limited [2-5], as is evidence regarding cost-effectiveness. This causes uncertainty about the effectiveness of eHealth and constitutes a barrier towards successful implementation in daily practice [6,7]. Thus, it is necessary to assess both effectiveness and cost-effectiveness to convince colleagues and policymakers of its added value.We assessed the cost-effectiveness of online asthma care for children alongside a randomised controlled trial (RCT) to evaluate the effectiveness of this eHealth intervention on health improvement [8]. In this RCT, 210 asthmatic children were randomly allocated into two groups of asthma management. In the usual care (UC) group, care consisted of routine 4-monthly outpatient visits where asthma control was assessed with an asthma control test (ACT)/children's asthma control test (C-ACT) [9]. Alternatively, in the virtual asthma clinic (VAC) group, outpatient visits were reduced by 50% and asthma control was monitored online with monthly web-based ACT/C-ACT tests. In the VAC group, children had more symptom-free days per month and their ACT/C-ACT scores were more improved. As such, this RCT proved that routine outpatient visits can partly be replaced by online asthma management using the VAC.We carried out an a priori defined cost-effectiveness analysis with the hypothesis that online management via the VAC is cost-effective. Standard cost questionnaires were completed by the parents every 4 months to assess costs from both a healthcare and a societal perspective. Healthcare (or direct) costs included all costs related to medical conditions, prescribed medication and intervention costs (including development of the VAC and estimated hosting and licence costs). Societal (or indirect) costs consisted of the loss of productivity, travel costs for any medical condition and parking expenses. The costs were based on the Dutch guideline for cost analyses [10] although if prices were not available other sources were used. Prices were converted to the 2014 level using the Dutch consumer price index [11].Mean incremental costs were weighted against the mean incremental effects in terms of asthma-related quality of life (QoL) and asthma control. Uncertainty boundaries of 95% for the incremental cost-effectiveness ratio (ICER) were determined nonparametrically using bootstrap analyses. In this bootstrap simulation, 1000 random samples of cost-effect pairs were selected with replacement. Results from the simulation were presented graphically in a scatter plot in which each dot signifies the ICER of one iteration of the bootstrap stimulation. Two validated questionnaires...

The aim of this study was to evaluate the impact of a structured screening and nurse-based intervention on cardiovascular risk factors. In patients with established cardiovascular disease, a cardiovascular risk profile was assessed, and lifestyle was evaluated by using an automated questionnaire. A multidisciplinary team proposed an integral individualized plan of care on the basis of these assessments. During follow-up, a nurse-led lifestyle intervention program and the best medical treatment were offered. A total of 328 outpatients were included. After screening, a follow-up term of at least 1 year was reached in 176 patients (59.9%). Low-density lipoprotein cholesterol and systolic blood pressure were significantly reduced. A reduction in the amount of smoking, alcohol consumption, and unhealthy eating habits was observed. However, the amount of physical activity was unaffected, and body mass was increased. A structural evaluation of cardiovascular risk factors and an integrated nurse-led approach can successfully reduce risk in cardiovascular patients.

Dealing with paediatric asthma in daily practice, we are mostly interested in the airway function: the hallmark of asthma is the variability of airway patency. Various pulmonary function tests (PFT) can be used to quantify airway caliber in asthmatic children. The choice of the test is based on the developmental age of the child, knowledge of the diagnosis/underlying pathophysiology, clinical questions and reasoning, and treatment. PFT is performed to monitor the severity of asthma and the response to therapy, but can also be used as a diagnostic tool, and to study growth and development of the lungs and airways.This review aims to provide clinicians an overview of the differences in assessing PFT in infants and preschool children compared with older cooperative children, which tests are feasible in infants and young children, the limitations of and usefulness of these tests, and of their interpretation in these age groups. The Authors: Lara S. van den Wijngaart, MD, MSc, is a registrar paediatrics at the Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands. She also has a master's degree in health science and is involved in research on e-health in children with asthma. Jolt Roukema, MD, PhD, is a paediatric pulmonologist at the Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands. His interests are on innovation and diagnostic research in paediatrics, and he is currently involved in research and clinical projects on e-health in children with asthma and cystic fibrosis and patients with allergic rhinitis. Peter J.F.M. Merkus, MD, PhD, is paediatric pulmonologist at the Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands. He is involved in publications and guidelines on paediatric and infant lung function testing, and clinical research into diagnostic techniques and treatment in children with asthma and cystic fibrosis.