One of the biggest challenges I’ve faced with caring for children with asthma is my inability to accurately assess the frequency of symptoms between healthcare visits. I too often rely on questions such as “In the past three months…” or “How many days this past week…”, both of which place a heavy burden on parents and children to recall a great deal of information. In this month’s Pediatrics, Nkoy and colleagues (10.1542/peds.2018-1711) share their experiences with a web and mobile-web application that supports children and families in monitoring asthma symptoms. The electronic-Asthma Tracker (e-AT) utilizes a modified version of the validated asthma control test (ACT)1,2 to assess control of symptoms while providing recommendations for interventions based on an individual’s degree of symptom control. The clever approach of the e-AT interface allows patients and families to visualize a timeline of asthma control scores and receive alerts from their primary care provider, as well as reminders to take controller medications. After development of the e-AT, the question remained: does it work in a real world setting? In this study, Nkoy et. al. set out to determine just that.
Study authors recruited 11 separate general pediatric ambulatory clinics for implementation of the e-AT into a clinical setting (although only 9 were included in the final analysis). Children 2-17 years of age with persistent asthma were enrolled for participation and provided with standardized teaching on how to use the e-AT interface. Use of the electronic tool was incentivized by offering points for completing weekly surveys regarding symptom control. Participants received congratulatory messages and gift cards when meeting point milestones and could also compare their scores to other study participants on a leader board. Children using the e-AT were then compared to matched controls from the same clinics without exposure to the e-AT. The primary outcome for the study was asthma-related quality of life (QOL) at baseline, 3, 6, and 12 months of follow-up.
A total of 325 children from the experimental group were included in the final analysis. Mean child QOL scores increased significantly after three months of using the e-AT and remained elevated throughout the 12-month study period. Similarly, asthma control scores displayed a sustained improvement in asthma symptoms beginning after three months of e-AT use. Improvement in QOL and asthma control was further associated with fewer emergency department visits/hospital admissions (intervention effect RR 0.41; 95% CI: 0.22-0.75) and oral corticosteroid use (RR 0.65; 95% CI: 0.46-0.93) compared to the matched controls.
Overall, these data suggest that the e-AT platform can improve asthma control in pediatric patients and reduce the utilization of emergency and hospital services as well as oral corticosteroid use. Equally important are the findings that these improvements happen early after use of the e-AT, with the effects sustained for at least a year. Such an early payoff of the e-AT could perhaps justify the capital necessary to implement this tool in an ambulatory setting. Study authors point out that their results are limited by a lack of randomized controls and the potential for bias this introduces. The generalizability of these results is also limited considering that each clinic was assisted by a clinic care coordinator with 15% FTE dedicated to using the e-AT in patient care. This is a substantial amount of time investment for a single disease for most ambulatory clinics. However, the relative ease of use of the e-AT and sustained results could prove beneficial for clinics in the long term. Despite some of these limitations, the results by Nkoy et. al. are promising and highlight the power of technology-assisted monitoring of symptoms in improving a pediatric provider’s ability to follow control of a chronic disease. Check out the results for yourself in this month’s Pediatrics!
References
1. Nkoy F, Stone B, Fassl B, et. al. Development of a Novel Tool for Engaging Children and Parents in Ashmta Self-management. AMI Annual Symposium proceedings AMIA Symposium 2012; In press.
2. Liu AH, Zeiger R, Sorkness C, et. al. Development and cross-sectional validation of the Childhood Asthma Control Test. The Journal of Allergy and Clinical Immunology 2007;119:817-25
