Electronic Monitoring and Feedback to Improve Adherence in Pediatric Asthma

Spaulding, Scott; Devine, Katie A.; Duncan, Christina L.; Wilson, Nevin W.; Hogan, Mary Beth

doi:10.1093/jpepsy/jsr059

Cited by 42 publications

(46 citation statements)

References 31 publications

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“…36 Although this study lacked a control group and the sample size was small (n = 5), it demonstrated a trend for improvement in subjective (e.g. proper medication technique and parental report of asthma functional severity) and objective outcomes including electronic medication monitoring of inhaled corticosteroid use.…”

Section: Resultsmentioning

confidence: 89%

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Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review

Mosnaim

Pappalardo²,

Resnick

et al. 2016

The Journal of Allergy and Clinical Immunology: In Practice

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Background Factors at multiple ecological levels, including the child, family, home, medical care, and community, impact adolescent asthma outcomes. Objective This systematic review characterizes behavioral interventions at the child, family, home, medical system, and community level to improve asthma management among adolescents. Methods A systematic search of PubMed, SCOPUS, OVID, PsycINFO, CINAHL, and reference review databases was conducted from January 1, 2000 through August 10, 2014. Articles were included if the title or abstract included asthma AND intervention AND (Education OR self-management OR behavioral OR technology OR trigger reduction); and the mean/median age of participants was between eleven and sixteen years. We compared populations, intervention characteristics, study designs, outcomes, settings, and intervention levels across studies to evaluate behavioral interventions to improve asthma management for adolescents. Results Of 1230 articles identified and reviewed, 24 articles (21 unique studies) met inclusion criteria. Promising approaches to improving adherence to daily controller medications include: objective monitoring of inhaled corticosteroid adherence with allergist/immunologist feedback on medication taking behavior and school nurse directly observed therapy. Efficacy at increasing asthma self-management skills was demonstrated using group interactive learning in the school setting. This systematic review is not a meta-analysis, thus limiting its quantitative assessment of studies. Publication bias may also limit our findings. Conclusions Novel strategies to objectively increase controller medication adherence for adolescents include allergist/immunologist feedback and school nurse directly observed therapy. Schools, the most common setting across studies in this review, provide the opportunity for group interactive learning to improve asthma knowledge and self-management skills.

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Section: Resultsmentioning

confidence: 89%

“…36 In this pilot study, inhaled corticosteroid use was electronically monitored and bi-monthly feedback on medication taking behavior was provided to the adolescent and parent by an allergist/immunologist. 36 …”

Section: Resultsmentioning

confidence: 99%

Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review

Mosnaim

Pappalardo²,

Resnick

et al. 2016

The Journal of Allergy and Clinical Immunology: In Practice

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“…This is often due to the subjective nature of the adherence measurements used, with inaccurate information skewing the data towards the null hypothesis 16. When objective measurements have been used but no effect on control has been found, it is likely to be because the studies have been underpowered28 42 or included very mild asthmatics in whom suboptimal adherence does not have such an effect on clinical outcome 30. One study showed no relationship between preventer adherence and β agonist use,17 possibly reflecting the erratic use of β agonists, and their habitual regular use even in well-controlled asthmatics.…”

Section: What Are the Consequences Of Non-adherence?mentioning

confidence: 99%

“…Objective adherence monitoring with an EMD and structured feedback has been shown to increase adherence rates in children,28 42 although these studies used small numbers of patients and were insufficiently powered to detect any difference in clinical outcome. Larger studies in adults have shown increased adherence rates in patients who receive objective adherence feedback 9.…”

Section: What Interventions Can Improve Adherence?mentioning

confidence: 99%

Adherence in childhood asthma: the elephant in the room

Morton

Everard

Elphick

2014

Archives of Disease in Childhood

142

104

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Adherence to inhaled steroids is suboptimal in many children with asthma and can lead to poor disease control. Many previous studies in paediatric populations have used subjective and inaccurate adherence measurements, reducing their validity. Adherence studies now often use objective electronic monitoring, which can give us an accurate indication of the extent of non-adherence in children with asthma. A review of the studies using electronic adherence monitoring shows that half of them report mean adherence rates of 50% or below, and the majority report rates below 75%. Reasons for non-adherence are both intentional and non-intentional, incorporating illness perceptions, medication beliefs and practical adherence barriers. Interventions to improve adherence in the paediatric population have had limited success, with the most effective containing both educational and behavioural aspects.

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“…Further to monitoring and recording, devices with e-connectivity are being developed enabling patients to receive real-time feedback about their inhaler technique every time they use their inhaler. In a recent proof-of-concept study conducted in children with asthma, the use of smart inhalers resulted in the improvement of inhaler technique which continued even after the feedback from the inhaler was withdrawn [103]. In fact, even though the future capability of e-connectivity and mHealth is still to be realized, there is such enthusiasm for it, its role in research and clinical practice [94], that it has been proposed that all inhalers include this monitoring capability [104].…”

mentioning

confidence: 99%

Identifying Critical Errors: Addressing Inhaler Technique in the Context of Asthma Management

et al. 2018

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Medication use has always played a highly significant role in the overall management of asthma, with appropriate use being linked to good asthma control. However, while patients with asthma enjoy the 'luxury' of having medications delivered directly to the lungs via inhaler devices, with that comes the additional challenge of ensuring that inhaler devices are used correctly. Research and practice provides evidence to the challenges associated with inhaler use and the particular steps that patients perform incorrectly. While this problem is well documented, acknowledged and reported, little has changed in 40 years, and the proportion of patients using inhaler devices remains unacceptably high. This review focuses on aspects specific to the errors that patient's make, the significance of these errors, and the important considerations for health care practitioners in supporting patients in correctly using their inhalers. This review highlights the complexities associated with patient's making inhaler technique errors and highlights the opportunities that lie in future technological developments of inhaler devices. Now more than ever, in the era of precision medicine, it is important that we address inhaler technique use once and for all.Keywords: Asthma control; Critical errors; Health behavior; Health care practitioners; Inhaler devices; Maintenance; Mastery; Skills THE IMPORTANCE OF MEDICATION USE IN OUR UNDERSTANDING OF RESPIRATORY DISEASEAfter decades of research, practice, and perceived knowledge, we find ourselves at crossroads in our understanding and management of airway diseases, such as asthma [1]. While asthma is an obstructive airways disease, which Pulm Ther (2018) 4:1-12 https://doi.org/10.1007/s41030-018-0051-0 to our current knowledge can neither be prevented nor cured, it is a disease that fluctuates in severity and 'control', is exacerbated by varying triggers, and its course over an individual's lifetime is essentially unpredictable [1]. While the conversation about asthma and airways disease more broadly is not the focus of this review, it becomes particularly relevant in our consideration of the use of medications. It is critical, now more than ever, that we understand the role of medication use, as it can provide us with further understanding about respiratory disease more broadly [2]. Given that asthma management is reliant on the use of medications [3], ensuring that patients use their medications correctly has become more than just a practical matter; it is a complex and critical issue. Correct medication use has become a fundamental step in our exploration and understanding of disease traits [1,2]: with careful and more precise evaluation of patient's response to treatment becoming integral to our understanding of disease endotypes and our evolution towards precision medicine [1,2]. For this reason, if for no other, it is now more important than ever that we address inhaler use, especially our knowledge of critical errors, which can 'cloud' our understanding of treatment success. T...

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Electronic Monitoring and Feedback to Improve Adherence in Pediatric Asthma

Abstract: Results support the use of objective monitoring devices for assessing pediatric asthma patients' adherence and indicate that feedback from medical staff may improve and maintain medication adherence for some patients.

Cited by 42 publications

References 31 publications

Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review

Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review

Adherence in childhood asthma: the elephant in the room

Identifying Critical Errors: Addressing Inhaler Technique in the Context of Asthma Management

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