Technology based interventions can improve patient reported outcomes in asthma
Published Online: June 2021
Technology-based interventions (TBIs) can improve asthma management by facilitating patient education, symptom monitoring, environmental trigger control, comorbid condition management, and medication adherence. Many types of TBIs exist, including online portals, multimedia education, telehealth, and adherence monitoring devices. As technology continues to develop, clinicians should focus on interventions that have been validated through clinical trials and shown to improve outcomes. Patient reported outcomes (PROs) are obtained directly from the patient and are particularly important because they provide information about the patient’s disease burden that may not be reflected in conventional clinical metrics. Several types of PROs exist, including quality of life, disease control, and attitudes about medications. The objectives of this systematic review are as follows: identify the TBIs that have been evaluated in asthma clinical trials using PROs as endpoints; identify the PROs most commonly used in these trials; and determine the impact of TBIs on PROs when compared with usual care in patients with asthma.
This review recently published in The Journal of Allergy and Clinical Immunology: In Practice by Doshi et al. included studies published in English between January 2000 and February 2020 that investigate the impact of TBIs on PROs in asthma. We searched the PubMed and ClinicalTrials.gov databases using the following keywords: “asthma,” “IT-based interventions,” “information technology,” “technology,” “dyspnea,” “patient reported outcomes,” “PROs,” “telehealth,” “telemedicine,” and/or “mobile devices”. Two independent reviewers selected the studies to include in the analysis based on a multistep process. If both reviewers agreed, then the study would be included in the analysis. If the reviewers disagreed, then a deliberation was performed to reach consensus. A third reviewer would only be considered if consensus could not be reached by deliberation. The following data items were then extracted from the included studies: age group of participants (adult, pediatric, both, or not speciﬁed); number of participants included in the study; intervention(s) performed; outcome(s) analyzed; and study results. The characteristics of the studies including types of intervention and PRO were summarized.
The initial search identified 959 unique citations. Of these, 14 were included in the final analysis. Five different types of TBIs were identiﬁed among the studies: internet-based self-reporting tools, electronic medication monitoring devices, electronic diaries, multimedia education, and telehealth visits. The most common intervention was multimedia education, used in 9 of the studies as either part or all of their intervention. Similarly, 4 different types of PROs were collected among the studies: asthma severity, asthma control, treatment self-efﬁcacy, and quality of life. All studies collected multiple PROs. Treatment self-efﬁcacy was the most commonly assessed, used in 11 studies. Of the 14 studies, 12 showed a positive outcome in at least one of the PRO domains. The outcome domain that most consistently improved with a TBI was treatment self-efﬁcacy, with improvement seen in 73% of studies using the domain. The outcome domain that showed the least improvement was asthma severity, which did not improve in any of the studies where that metric was collected. The instruments used to measure PROs varied widely between studies, which limits our ability to compare outcomes across studies.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.