Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial

Abstract

Objective To determine whether mobile phone based monitoring improves asthma control compared with standard paper based monitoring strategies.Design Multicentre randomised controlled trial with cost effectiveness analysis.Setting UK primary care.Participants 288 adolescents and adults with poorly controlled asthma (asthma control questionnaire (ACQ) score ≥1.5) from 32 practices.Intervention Participants were centrally randomised to twice daily recording and mobile phone based transmission of symptoms, drug use, and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring. Main outcome measuresChanges in scores on asthma control questionnaire and self efficacy (knowledge, attitude, and self efficacy asthma questionnaire (KASE-AQ)) at six months after randomisation. Assessment of outcomes was blinded. Analysis was on an intention to treat basis. ResultsThere was no significant difference in the change in asthma control or self efficacy between the two groups (ACQ: mean change 0.75 in mobile group v 0.73 in paper group, mean difference in change −0.02 (95% confidence interval −0.23 to 0.19); KASE-AQ score: mean change −4.4 v −2.4, mean difference 2.0 (−0.3 to 4.2)). The numbers of patients who had acute exacerbations, steroid courses, and unscheduled consultations were similar in both groups, with similar healthcare costs. Overall, the mobile phone service was more expensive because of the expenses of telemonitoring.Conclusions Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines standards. The mobile technology was not cost effective. Trial registration Clinical Trials NCT00512837. IntroductionGlobally, an estimated 300 million people have asthma, presenting a considerable and increasing burden of disease to healthcare systems, families, and patients.1 Despite two decades of asthma guidelines, 2 asthma remains poorly controlled in a substantial proportion of people.3 Structured asthma management-which in the United Kingdom is predominantly delivered in primary care 4 -can improve outcomes in terms of exacerbations, admissions to hospital, and days lost from school and work. 5 The concept of supported self management, engaging both clinicians and patients in delivering and implementing regular monitoring of control and adjustment of treatment, is a key recommendation of national and international guidelines. The theoretical model developed by Glasziou and colleagues, using asthma as an exemplar, describes the complementary and evolving roles of periodic support from professionals and RESEARCHongoing self monitoring by patients. 8 Our recent qualitative study suggests that people with asthma perceive a role for mobile technology in aiding transition from clinician supported phases while control is gained to effective self management during maintenance phases. 9Poor adherence to monitoring and drugs is a potentially modifiable factor associated wit...

Performance assessment of a closed-loop system for diabetes management

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Evaluating the impact of the Eastern Academic Health Science Network Transformation Support Unit

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Digital technology in respiratory diseases

“…1 In a world where digital technology has revolutionized the way we work, shop and manage our finances, it is unsurprising that digital systems are suggested as potential solutions. 2,3 However, recent evidence suggesting that telehealth may not be quite the panacea that was promised [4][5][6] has led to discussions on the mechanisms and role of digital technology in respiratory care. This series of papers, reflects the debate and we hope that, by offering reasoned arguments, it may help to shape a new paradigm.…”