mHealth Intervention for Pediatric Asthma Boosts Adherence, ATC Scores

Our mobile devices are slowly and steadily weaving themselves into the fabric of our society. Healthcare — while a bit slower to adapt to this sea change – is no exception. In fact, cell phones have recently become the cornerstone of an entire branch of healthcare called mobile health, or mHealth for short, whose fundamental aim is to increase patient engagement with the healthcare system.

While excitement (and hype) surrounding mHealth’s potential to build stronger patient-provider relationships and improve outcomes abounds, early results around its efficacy are murky. Published studies of cell phone-based healthcare interventions are generally of low quality, leaving anyone looking to draw conclusions about the subject’s efficacy forced to do so with a grain of salt.

But now, investigators at Boston Children’s Hospital are seeing some promising mHealth results in a small sample of children with asthma. After placing 26 of these patients between the ages of 6 and 17 on an mHealth tracking system for asthma management, the study met its primary endpoint of positive changes in Asthma Control Test (ACT) scores, as well as its secondary endpoint of a positive change in adherence rates and self-reported satisfaction from the device.

The study group was made of 26 patients between the ages of 6 and 17 with a diagnosis of asthma, who were enrolled in the study for a period of 12 weeks. Participants each received an electronic monitoring device paired with a mobile app to support adherence to a controller inhaler. There were 2 phone call follow-ups at 4 and 8 weeks, and a final visit at 12 weeks. Outcomes measured were changes in ACT score, caregiver satisfaction, and medication adherence.

According to the study authors led by Leili Behrooz, MD, MPH, participants were 62% male and 38% female with a mean age of 9.1 years. Based on ACT scores, 28% of participants with uncontrolled asthma at baseline became controlled at final visit. “This improvement was observed at 4 weeks follow up and remained improved until the end of the study,” the authors wrote.

Non-adherence score increased from 1.1 at baseline to 1.9 at final visit (P=.10). 57% of participants reported no use of rescue medication at final visit, versus 36% at baseline. Moreover, 87% of caregivers reported that they would recommend the device and app to friends, and 78% found the device to be an effective tool for the management of asthma.

In a systematic review of mHealth interventions published in early 2018 in the Journal of Medical Internet Research, researchers found that mHealth interventions are generally effective for asthma maintenance. Positive impact has been demonstrated with moderate-quality evidence that text messaging interventions showed greater improvements in the pooled symptom score (mean difference 0.36, 95% CI) compared with a control group.

The review also found that mHealth interventions can increase adherence to treatment among patients with many conditions, including diabetes, hepatitis A and C, and asthma.

The study provided a “thorough review of available evidence on effectiveness of mHealth interventions in different health conditions, and in the processes of health care service delivery, so it is useful to guide clinical and health policy decisions,” wrote review author David Novillo-Ortiz, MLIS, MSc, PhD. Still, he acknowledged several limitations, including lack of assessment of risks, consumer satisfaction, and acceptability of the intervention.

“More attention to cost implications seems warranted,” he wrote. “Additionally, future studies should compare effects in different contexts.”