Medicines Optimisation Innovation Centre, Northern Health and Social Care Trust, Antrim, UK.
Department of Respiratory Medicine, Western Health and Social Care Trust, Derry, UK.
BMJ Open Qual. 2024 Jul 15;13(3):e002626. doi: 10.1136/bmjoq-2023-002626.
Adherence to pharmacotherapy and use of the correct inhaler technique are important basic principles of asthma management. Video- or remote-direct observation of therapy (v-DOT) could be a feasible approach to facilitate monitoring and supervising therapy, supporting the delivery of standard care.
To explore the utility and the feasibility of v-DOT to monitor inhaler technique and adherence to treatment in adults attending the asthma outpatient service in a tertiary hospital in Northern Ireland.
The project evaluated use of the technology with 10 asthma patients. Patient and clinician feedback was obtained, in addition to measures of patient engagement and disease-specific clinical markers to assess the feasibility and utility of v-DOT technology in this group of patients.
The engagement rate with v-DOT for participating patients averaged 78% (actual video uploads vs expected video uploads) over a median 7 week usage period. Although 50% of patients reported a technical issue at some stage during the usage period, all patients and clinicians reported that the technology was easy to use and that they were satisfied with the outcomes. A range of positive impacts were observed, including optimised inhaler technique and an observed improvement in lung function. An increase in asthma control test scores aligned with clinical aims to promote adherence and alleviate symptoms.
The v-DOT technology was shown to be a feasible method of assessing inhaler technique and monitoring adherence in this small group of adult asthma patients. A range of positive impacts for participating patients and clinicians were observed. Not all patients invited to join the project agreed to participate or engage with using the technology, highlighting that in this setting, digital modes of delivering care provide only one of the approaches in the necessary "tool kit" for clinicians and patients.
药物治疗的依从性和正确使用吸入器技术是哮喘管理的重要基本原则。视频或远程直接观察治疗（v-DOT）可能是一种可行的方法，可促进监测和监督治疗，支持标准护理的提供。
探索 v-DOT 监测吸入器技术和治疗依从性在北爱尔兰一家三级医院的哮喘门诊成人患者中的应用。
该项目评估了 10 名哮喘患者对该技术的使用情况。除了评估患者参与度和疾病特定临床标志物外，还获得了患者和临床医生的反馈，以评估 v-DOT 技术在这组患者中的可行性和实用性。
在 7 周的中位使用期间，参与患者的 v-DOT 参与率平均为 78%（实际视频上传与预期视频上传之比）。尽管 50%的患者在使用期间的某个阶段报告了技术问题，但所有患者和临床医生均表示该技术易于使用，并且对结果感到满意。观察到了一系列积极的影响，包括优化了吸入器技术，以及观察到肺功能的改善。哮喘控制测试评分的提高符合促进依从性和减轻症状的临床目标。
v-DOT 技术被证明是评估这一小部分成年哮喘患者吸入器技术和监测依从性的可行方法。观察到参与患者和临床医生的一系列积极影响。并非所有受邀参与该项目的患者都同意参与或使用该技术，这表明在这种情况下，数字医疗模式仅提供了临床医生和患者所需“工具包”中的一种方法。
