Division of Pediatric Behavioral Health, National Jewish Health, Denver.
Institute for Health Research, Kaiser Permanente Colorado, Aurora.
Med Care. 2020 Apr;58(4):352-359. doi: 10.1097/MLR.0000000000001265.
Challenges to health care efficiency are increasingly addressed with the help of digital communication technology tools (DCTs).
The objective of this study was to test whether DCT, compared with Usual Care, can reduce health care clinician burden without increasing asthma-related exacerbations among patients with asthma in a large integrated health care system.
The (Breathewell) program was a pragmatic, randomized trial at (Kaiser Permanente Colorado), where asthma nurses screen patients for poor symptom control when beta2-agonist refill requests came within 60 days of previous fill or in the absence of a controller medication fill within 4 months (beta2-agonist overfill). A total of 14,978 adults with asthma were randomized to Usual Care or 1 of 2 DCT intervention groups (Text/Phone call or Email).
Participants included adults 18 and older with an asthma diagnosis at the time of randomization and no history of chronic obstructive pulmonary disease.
Primary outcome measures included asthma-related health care resource utilization (eg, asthma nurse contacts), medication use, and exacerbations.
A total of 1933 patients had 4337 events which met beta2-agonist overfill criteria. Of the 2874 events in the intervention arm, 1188 (41%) were resolved by DCT contact and did not require additional clinician contact. Asthma medication use and exacerbations over 12 months did not differ among the 3 groups.
DCT tools can successfully contact adult asthma patients to screen for symptoms and facilitate intervention. The absence of differences in medication fills and health care utilization indicates that the strategic replacement of nursing interventions by digital outreach did not reduce treatment adherence or compromise health care outcomes.
数字通信技术工具（DCT）的应用日益解决医疗保健效率面临的挑战。
本研究旨在检验与常规护理相比，DCT 是否可以在大型综合医疗保健系统中减少哮喘患者的临床医生负担，而不会增加哮喘相关恶化。
（Breathewell）计划是在（凯撒永久科罗拉多）进行的一项实用、随机试验，哮喘护士在β2-激动剂续药请求在之前续药后 60 天内或在 4 个月内没有使用控制器药物时（β2-激动剂过量）筛选出症状控制不佳的患者。共有 14978 名成年哮喘患者被随机分配到常规护理或 2 个 DCT 干预组（短信/电话或电子邮件）。
参与者包括随机分组时患有哮喘诊断且无慢性阻塞性肺疾病病史的 18 岁及以上成年人。
主要结局测量包括与哮喘相关的医疗保健资源利用（例如哮喘护士接触）、药物使用和恶化。
共有 1933 名患者有 4337 次符合β2-激动剂过量标准的事件。在干预组的 2874 次事件中，有 1188 次（41%）通过 DCT 联系得到解决，无需额外的临床医生联系。在 12 个月内，3 组患者的哮喘药物使用和恶化情况没有差异。
DCT 工具可以成功联系成年哮喘患者进行症状筛查并促进干预。药物使用和医疗保健利用方面的差异表明，通过数字外展策略替代护理干预并未降低治疗依从性或影响医疗保健结果。
