Feasibility of video observed therapy to support controller inhaler use among children in West Baltimore

Abstract

Objective: To assess feasibility of a novel video directly observed therapy (DOT)-based digital asthma program intended to support correct inhaled corticosteroid (ICS) use among children. Methods: We conducted a 60-day pilot study among patients 2-18 years attending a primary care clinic with prescribed ICS and sub-optimally controlled asthma (recent hospitalization, ICS nonadherence, frequent rescue inhaler use, therapy escalation, or Asthma Control Test <20). Participants used a mobile application to receive reminders, submit videos of ICS doses (video DOT), and receive asynchronous feedback on adherence and inhaler technique. We assessed enrollment, engagement, program metrics, and user experience; adherence and inhaler errors were secondary outcomes. Results: Of 26 eligible patients, 21 (81%) enrolled and submitted ≥1 video; median age was 11 years (8-15), 71% were male, 90% had Medicaid, and 62% experienced ≥1 exacerbation in the previous 6 months. Retention was 57% and 52% at week 5 and 8, respectively. Participants submitted 810 videos. Missed doses, inhaler errors (n = 247) and adherence issues (n = 107) prompted 543 communications; inadequate inspiration or holding breath were most common. Among 16 patients with engagement >7 days and >4 videos, median inhaler error rate (proportion of videos with ≥1 error) decreased from week 1 to week 2 (73% vs 8%, p ≤ 0.05) with median adherence >80%. Participants experienced the program as long, but easy to use; benefits included building routines, skill, and independence. Conclusions: This pilot study suggests high program acceptability among our cohort. High engagement with improved inhaler technique over the first 14 days suggests shorter implementation.

Medication Adherence in Children with Asthma

“…vDOT has been reported as fun and enjoyable to use for the families 50 and aids with the development of good routines and independence. 51 …”

“…10 vDOT has been reported as fun and enjoyable to use for the families 50 and aids with the development of good routines and independence. 51 Due to the fact that a trained healthcare professional must review individual patient videos, vDOT is often reserved for those patients with difficult to treat asthma. However, all patients prescribed an inhaler could potentially benefit from the personalised feedback vDOT provides.…”

The use of remote video directly observed therapy to improve both inhaler technique and adherence to asthma medications

“…A second feasibility study of vDOT for children with asthma reported that participants experienced the program as long (in their case the period of vDOT was 8 weeks), but easy to use. The benefits included building routines, improving skill, and independence ( 18 ).…”

“…This pilot study suggested that use of this platform was acceptable to this population. Inhaler technique could be improved if patients continued to engage beyond 1 week but retention was low at about 50% over 8 weeks and users felt like this program was too long ( 18 ).…”

Study protocol for ADHERE (Applying Directly observed therapy to HydroxyurEa to Realize Effectiveness): Using small business partnerships to deliver a scalable and novel hydroxyurea adherence solution to youth with sickle cell disease

“…To address these challenges and promote equitable access and scalability of VDOT for youth with SCD in clinical practice, the study team partnered with Scene Health, Baltimore, MD (formerly emocha Mobile Health Inc.). Scene Health is a small business that offers a userfriendly mobile technology platform, a technology-enabled review service, extensive experience successfully engaging populations affected by both infectious and chronic diseases to report medication adherence with VDOT, [35][36][37][38][39] and commercial partnerships with health insurers. This partnership provides an opportunity to assess the feasibility and scalability of VDOT and electronic adherence monitoring in a pilot RCT.…”