Controller adherence following hospital discharge in high risk children: A pilot randomized trial of text message reminders

Abstract

Objective: Our objective was to assess the feasibility of a mobile health, inhaled corticosteroid (ICS) adherence reminder intervention and to characterize adherence trajectories immediately following severe asthma exacerbation in high risk urban minority children with persistent asthma. Methods: Children ages 2–13 with persistent asthma were enrolled in this pilot randomized controlled trial during an asthma emergency department (ED) visit or hospitalization. Intervention arm participants received daily text message reminders for 30 days, and both arms received electronic sensors to measure ICS use. Primary outcomes were feasibility of sensor use and text message acceptability. Secondary outcomes included adherence to prescribed ICS regimen and 30-day adherence trajectories. Group-based trajectory modeling was used to examine adherence trajectories. Results: Forty-one participants (mean age 5.9) were randomized to intervention (n=21) or control (n=20). Overall, 85% were Black, 88% had public insurance, and 51% of the caregivers had a high school education or less. Thirty-two participant families (78%) transmitted medication adherence data; of caregivers who completed the acceptability survey, 25 (96%) chose to receive daily reminders beyond that study interval. Secondary outcome analyses demonstrated similar average daily adherence between groups (intervention=36% vs control=32%, P=0.73). Three adherence trajectories were identified with none ever exceeding the 80% threshold. Conclusions: Within a high risk pediatric cohort, electronic monitoring of ICS use and adherence reminders delivered via text message were feasible for most participants, but there was no signal of effect. Adherence trajectories following severe exacerbation were suboptimal, demonstrating an important opportunity for asthma care improvement.

They just don't take their medicines: Reframing medication adherence in asthma from frustration to opportunity

“…When all of these rates are combined, it is clear that actual medication delivery in high‐risk asthmatic children may be shockingly low. Even after a significant event such as an asthma exacerbation‐related hospitalization, adherence rates in high‐risk children have been shown to be as low as 34 to 40% 10 …”

“…Even after a significant event such as an asthma exacerbation-related hospitalization, adherence rates in high-risk children have been shown to be as low as 34 to 40%. 10 Poor rates of adherence to medication regimens affects healthcare-related outcomes. Lowered rates of adherence in asthma are associated with an increased risk of asthma exacerbations, 11 with one analysis in adults estimating that 24% of asthma exacerbations may be attributable to poor adherence to medications.…”

Parent Preferences for Methods and Content of Mobile Technology–Based Asthma Medication Adherence Intervention

“…Despite their effectiveness, asthma controller medications continue to be underused even among high-risk patients with recent hospitalization. 1,2 Authors of previous studies have attempted to improve medication adherence in children and adults with asthma through technologybased modalities, including interactive voice-recognition phone calls triggered by refill patterns, home-based asthma education with adherence feedback, discharge follow-up phone calls, and electronic adherence monitoring devices with audiovisual reminders. [3][4][5][6][7][8][9] Efforts are underway to determine the efficacy of text message reminders coupled with adherence monitoring devices specifically aimed at improving medication adherence among children recently hospitalized or treated in an emergency department (ED) for asthma.…”

“…[3][4][5][6][7][8][9] Efforts are underway to determine the efficacy of text message reminders coupled with adherence monitoring devices specifically aimed at improving medication adherence among children recently hospitalized or treated in an emergency department (ED) for asthma. 1 Feasibility and acceptability are suggested in early results. 1 Targeting mobile technology adherence interventions to patients at highest risk for exacerbation, such as those who are recently hospitalized, allows for a more efficient use of limited resources.…”

“…1 Feasibility and acceptability are suggested in early results. 1 Targeting mobile technology adherence interventions to patients at highest risk for exacerbation, such as those who are recently hospitalized, allows for a more efficient use of limited resources. Additionally, early engagement of parents of children with asthma during the design of future technology-based asthma risk communication and/or adherence promotion interventions will improve potential acceptability and effectiveness.…”