Going mobile with primary care: smartphone-telemedicine for asthma management in young urban adults (TEAMS)

Abstract

Background: The majority of adults with persistent asthma have chronically uncontrolled disease and interventions to improve outcomes are needed. We evaluated the efficacy, feasibility, and acceptability of a multi-component smartphone-telemedicine program (TEAMS) to deliver asthma care remotely, support provider adherence to asthma management guidelines, and improve patient outcomes. Methods: TEAMS utilized: (1) remote symptom monitoring, (2) nurse-led smartphone-telemedicine with self-management training for patients, and (3) Electronic medical recordbased clinical decision support software. Adults aged 18-44 (N ¼ 33) and primary care providers (N ¼ 4) were recruited from a safety-net practice in Upstate New York. Asthma control, quality of life, and FEV 1 were measured at 0, 3 and 6 months. Acceptability was assessed via survey and end-of-study interviews. Paired t-test and mixed effects modeling were used to evaluate the effect of the intervention on asthma outcomes. Results: At baseline, 80% of participants had uncontrolled asthma. By 6-months, 80% classified as well-controlled. Improvements in control and quality of life were large (d ¼ 1.955, d ¼ 1.579). FEV %pred increased 4.2% (d ¼ 1.687) with the greatest gain in males, smokers, and lower educational status. Provider adherence to national guidelines increased from 43.3% to 86.7% (CI ¼ 22.11-64.55) and patient adherence to medication increased from 45.58% to 85.29% (CI ¼ 14.79-64.62). Acceptability was 95.7%; In follow up interviews, 29/30 patients and all providers indicated TEAMS worked better than usual care, supported effective selfmanagement, and reduced symptoms over time, which led to greater self-efficacy and motivation to manage asthma. Discussion: Based on these findings, we conclude that smartphone telemedicine could substantially improve clinical asthma management, adherence to guidelines, and patient outcomes.

User Experience Design for Adoption of Asthma Clinical Decision Support Tools

“…9,20, 26,47 Readily accessible EHR tools at the point of care were favored. 12,14,20 -22,35,37,38,51 Standardized asthma guideline-based tools were seen as a facilitator to routinely capture relevant information 22,26,35,40,52 and educate. 26,32,35 Barriers to adoption included technology limitations, 9,14,21,42,43,53 incompatible operating systems, inappropriate practice software, manual data entry, or extra steps.…”

“…9, 26,47 Valued content also included features that increased communication and patient engagement, increased asthma medication adherence, enhanced patient-provider relationships, 10,40 and allowed more time to focus on asthma care to engage in collaborative problem solving, decisions, goal setting, and patient education. 10,12,20,22,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]46,53,54 Content-related barriers included lack of features to meet provider needs. 9,14,21,53 For example, some systems did not contain all necessary data for useful decisions (e.g., relevant asthma comorbidity data), while others were too rigid without the ability to capture needed information for documentation purposes.…”

“…Twenty CDS systems were integrated with the electronic health record (EHR). 10,12,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] All but three studies were informed by guidelines, 14,21,44 and 18 used the…”

“…• If negative attitude toward the tool, unlikely to be adopted 22,[28][29][30][31]33,35,36,[38][39][40][41][45][46][47][48][49][50] Twenty-seven studies were with general practitioners, 9,10,12,14,26-29,31-43,45,46,49-52 four included subspecialists, 21,22,30,48 and four included both. 20,44,47,53 Common tool functionalities included determination of asthma control status, recommendation of medications, automatic note generation for EHR, and creation of an asthma action plan.…”

Isn’t There an App for That? The Role of Smartphone and Tablet Applications for Asthma Education and Self-Management in Adolescents

“…These devices can remind patients of appointments with text messages, but most commonly, they are used in mHealth through mobile applications (apps) [ 5 , 15 ]. Telemedicine has also been employed, allowing improved patient access to support and an encouragement of adherence [ 26 , 35 ].…”