Virtual teach-to-goal adaptive learning of inhaler technique for inpatients with asthma or COPD


Published Online: January 5, 2017

Asthma and chronic obstructive pulmonary disease (COPD) are two of the most common breathing disorders. Far too many patients who are hospitalized for these conditions return to the hospital within a month. Many of these readmissions are thought to be preventable because effective treatments exist to treat and control patient symptoms. One key area to target to decrease readmissions and improve overall patient health and outcomes is ensuring that patients understand when and how to use their inhalers to help curb symptoms and reduce exacerbations. A strategy called teach-to-goal (TTG) is an in-person, patient centered approach that begins with evaluating the patients’ existing skills prior to providing tailored education to patients to improve their technique. Although this TTG strategy has many strengths, it is resource intensive, requiring provider time and training, and lacks portability for at-home refresher education. We sought to develop a virtual-TTGTM  (V-TTG TM) educational intervention with use of self-directed adaptive learning technology. V-TTG TM provides patient-tailored learning sessions that are modeled after the in-person TTG sessions, but that can be accessed on any desktop or hand-held device, which increases its reach to patients outside of the health care system.

In this study published in The Journal of Allergy and Clinical Immunology: In Practice by Press and colleagues, the V-TTG TM intervention was tested for efficacy. The V-TTG TM session teaches correct inhaler technique for the metered-dose inhaler (MDI), the primary device type for rescue medication and a common device type for controller medication. Hospitalized adult patients with asthma or COPD who consented were enrolled and completed the interactive V-TTG TM session. V-TTG TM consists of a pre-assessment series of multiple choice and true/false questions about the proper inhaler technique, followed by a narrated video demonstration. Participants were then presented with a post-assessment series of the same short-answer questions with the addition of an applied skill question using a video with the incorrect technique shown. If they failed to answer any of post-education questions correctly, they were prompted to re-watch the narrated demonstration and repeat the post-assessment up to 3 times to customize the learning session to participants’ needs.

Ninety participants were enrolled, of whom 83 completed the study between November 2014 and October 2015. The mean age of participants was 48 years, and a majority of the participants were African American (94%), female (62%), and had asthma (68%). The V-TTG TM self-assessment item validation found that knowledge and confidence improved with each round of testing. With regard to V-TTG TM efficacy prior to completing the V-TTG TM session, the majority, 83%, misused MDIs, and only 7% demonstrated perfect technique. After the V-TTG session, there was significant improvement in MDI technique, with only 24% of participants still misusing the MDI and 46% of participants demonstrating perfect technique.

This study is the first to validate and demonstrate the efficacy of a self-directed personalized virtual learning tool, V-TTG TM, to teach inhaler technique. Because prior in-person educational interventions were limited in time and settings, this strategy that can first be used in the hospital and then repeated at home for reinforcement of the education addressed these important limitations. Prior to wide-scale implementation, larger, multi-center studies are needed to examine the relative effectiveness of this V-TTG TM video module education in comparison with other inhaler education approaches, across settings, and to determine whether V-TTG TM improves longer term retention and health outcomes.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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