Home and Community Care Digest
This one-year study demonstrated that Internet-based home monitoring of children with asthma is a viable option for families facing challenges in traveling to specialty care centers. 'Virtual' patients were compared to traditional office-based patients and various measures of therapeutic adherence and disease control were evaluated. The office-based and virtual groups exhibited similar performances in nearly all outcomes. However, use of the patient website declined steadily throughout the study period, which suggests that a one-year study period may be too short to assess the overall efficacy of this type of telemedicine.
Background: The use of telemedicine in home monitoring of children with asthma has focused primarily on real-time connections with medical professionals, which can be inconvenient for both patients and providers. This study describes a 1-year, randomized trial of Internet-based in-home monitoring for children with asthma that was compared to standardized, office-based care management.
Methods: Children (6-17 years old) with persistent asthma were solicited from a large population of children in Hawaii. During the 1-year study period, the office-based group (60 subjects) received 6 in-person visits, which included asthma education from their case manager. Patients were also required to complete a daily asthma symptom diary by hand. The virtual group (60 subjects) received 3 in-person visits and 3 scheduled virtual visits. Patients were required to complete an electronic daily asthma symptom diary and to upload several video recordings of the patient's flow meter and inhaler technique. Virtual visits through a custom designed website consisted of interactive asthma education, review of video recordings, and communication with the case manager. Several outcomes of both therapeutic adherence and disease control were measured, including use of prescribed asthma controller medication, daily completion of the asthma symptom diary, quality of inhaler technique, emergency use of health services and asthma knowledge retention.
Findings: The office-based and virtual groups exhibited similar performances in both therapeutic adherence and disease control. There was similar use of prescribed asthma controller medication, and emergency room and hospital visits were equally rare. The virtual group demonstrated 50% more diary usage compared to the office-based group, although this usage itself was quite low (once every 2.8 days vs. 4.8 days). For the virtual group, the number of inhaler technique videos submitted to the website was only one third of those expected from the treatment protocol. At the end of the study, the quality of inhaler technique was greater in the virtual group compared to the office-based group. The use of the patient website declined steadily throughout the study period, suggesting that a 1-year period may be too short to assess the overall efficacy of this type of telemedicine.
Conclusions: This study demonstrated that Internet-based home monitoring of children with asthma is a viable option for families facing challenges in traveling to specialty care centers. Both groups demonstrated significant improvement in asthma knowledge since the launch of the study. While both groups achieved excellent asthma therapeutic and disease control outcomes, it should be noted that this study compared highly intensive, rigorous approaches. As such, the findings may not be representative of a typical ambulatory treatment schedule. Although asthma education for both groups improved significantly from time of enrollment, it is hard to generalize because of the high baseline asthma knowledge. Effective ambulatory treatment of asthma was expected to decrease the number of asthma-related hospitalizations or use of emergency services. This study failed to demonstrate this. As such, it cannot be concluded that effective ambulatory treatment of asthma has eased the burden on the emergency health care system.
Reference: Chan DS, Callahan CW, Hatch-Pigott VB, Lawless A, Proffitt HL, Manning NE, Schweikert M, Malone FJ. "Internet-Based Home Monitoring and Education of Children With Asthma Is Comparable to Ideal Office-Based Care: Results of a 1-Year Asthma In-Home Monitoring Trial." Pediatrics 2007; 119:3: 569-78.
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