Asthma Tracking App Reduced Healthcare, Medication Use, Study Says

A health tracking app that monitors asthma control in children in real time and sends medication reminders successfully reduced emergency department (ED) visits as well as the use of inhaled corticosteroids (ICSs), according to a study published Thursday in Pediatrics.

The app, called the electronic—Asthma Tracker (e-AT), was developed by researchers at the University of Utah. Bryan Stone, MD, a senior author and University of Utah Health pediatrician, said the app connects directly to the provider’s office, giving them a child’s asthma control data in real time. By signaling impending loss of asthma control before it gets worse, it allows doctors to intervene before an ED visit or hospitalization is needed.

Asthma affects 8.3 million children in the United States and is most common pediatric illness that brings children into the hospital and ED; up to 40% of children hospitalized with asthma are readmitted within a year. More than 50% of children with asthma have poorly controlled disease.

Patients who struggle with asthma control may have limited self-management skills, may not have had sufficient education or support, may not recognize and take action when symptoms are getting worse, may not be adherent with therapy, or the prescribed therapy may not be adequate.

In an email to The American Journal of Managed Care^®, Stone said the interest in developing the app stemmed from a desire to “improve asthma care in children outside the hospital, after we had spent several years improving care in the hospital. After much thought, we decided an app that addressed self-monitoring and home management of asthma would be the best approach.”

Stone also said there are hopes that the app, and others like it, will expand; the University of Utah Center for Technology and Venture Commercialization is interested in commercialization of the app.

The prospective cohort study enrolled 327 children aged 2 to 17 years in Utah from January 2014 to December 2015 in 11 general pediatric clinics and asked them to use the e-AT weekly for 1 year. Nine of the 11 clinics are owned by Intermountain Healthcare; 2 were not.

Children or their parents used the app to answer a short weekly survey, which was adjusted from the standard Asthma Control Test, that asked patients to note their symptoms over the past 4 weeks and how the symptoms affected the ability to carry out daily activities. Based on scoring, the app shows a graphic display of asthma control and makes recommendations.

Participants had significantly (P <.001) increased quality of life, asthma control, and reduced missed school and work days, at 3, 6, and 12 months. Adherence with using the app at 12 months was 65%.

They had reduced 1-year postintervention ED/hospital admissions (rate ratio [RR], 0.68; 95% CI, 0.49-0.95) and ICS use (RR, 0.74; 95% CI, 0.61-0.91). Parent satisfaction remained high. Compared with matched controls, e-AT participants had reduced 1-year postintervention ED/hospital admissions (RR, 0.41; 95% CI, 0.22-0.75) and ICS use (RR, 0.65; 95% CI, 0.46-0.93).

In addition, there were 60% fewer missed school days and a 70% decrease in the number of days that parents missed work. Asthma control test scores increased from 18.8 to 22.9.

Asked about factors that contributed to the results, Stone said although the investigators are not exactly certain, “we believe the healthcare model the app supports, which includes ongoing ambulatory monitoring of asthma chronic control by the child’s doctor, was very important. The app was deployed by us to doctor’s offices, who then partnered with their patients to use the app to improve asthma care.”

Stone said that participants told the researchers that knowing their physician would see their child’s data in the app “added a lot of value,” with some saying their doctor’s office called quickly to find out why there was an abnormality and to intervene. Other possible factors include the fact that the app was developed with input from patients and their parents, as well as other stakeholders. It also uses validated asthma monitoring tools.

In addition, families were incentivized to use the app regularly and received a $10 gift certificate every month (ie, for every 4 weeks of completing the assessments). Another researcher with the project, Flory Nkoy, MD, MS, MPH, a research professor of pediatrics and director of research, Division of Inpatient Medicine at the university, said the app is secure and HIPAA compliant and can be deployed as a stand-alone or can be integrated within the electronic health records. He also said they are considering making it available through a health insurance plan in order to reach more patients.

Reference

Nkoy FL, Fassl BA, Wilkins VL, et al. Improved ambulatory management of childhood asthma using a novel self-management application [published online May 16, 2019]. Pediatrics. doi: 10.1542/peds.2018-1711.