Kaye Leanne, Vuong Vy, Patel Urvashi, Mager Douglas, Barrett Meredith A
ResMed Science Center, San Diego, CA, USA.
Evernorth Health Services, St. Louis, MO, USA.
NPJ Prim Care Respir Med. 2024 Dec 28;34(1):46. doi: 10.1038/s41533-024-00404-8.
Digital health platforms for asthma self-management have demonstrated promise in improving clinical and quality of life outcomes. However, few studies have examined such an approach in a real-world, fully remote setting. As such, we evaluated the benefit of an evidence-based digital self-management platform for asthma-both on its own and when integrated into an established virtual clinical service. We compared six-month outcomes of a digital self-management program plus virtual clinical oversight, called a therapeutic resource center, (DP + TRC) with a digital self-management-only (DP) program in patients with uncontrolled asthma. The DP included electronic medication sensors that captured the date and time of both short-acting beta agonist (SABA) and controller medication usage. The TRC included remote care oversight to promote inhaler adherence and address symptom worsening. SABA usage, controller adherence and program retention were assessed retrospectively using regression models controlling for age, enrollment year, controller/SABA use, and baseline asthma control status.18,584 DP patients (mean age (SD): 33 (14.6) yrs; 89.9% uncontrolled asthma) and 3440 DP + TRC patients (mean age (SD): 43.7 (15.6) yrs); 48.6% uncontrolled) were assessed. We observed significantly better six-month program retention (55% vs. 41%, p < 0.001) and controller adherence (54% vs. 45%, p < 0.001), but no statistically significant differences in mean SABA use (0.76 vs. 0.87 mean puffs/day; p = 0.158) for the DP + TRC vs. DP groups, respectively. From baseline to six months, both groups had similar reductions in mean daily SABA use (both p < 0.001) and improvements in the percent of SABA-free days (both p < 0.001). The proportion of patients with ≥80% controller adherence declined in both groups, but a larger relative decline was noted in the DP vs. DP + TRC group. A digital self-management platform for asthma management combined with virtual clinical oversight may offer a scalable solution that not only achieves reduced SABA use, but also promotes medication adherence and increases program retention.
用于哮喘自我管理的数字健康平台已在改善临床和生活质量结果方面展现出前景。然而，很少有研究在真实世界、完全远程的环境中检验这种方法。因此，我们评估了一个基于证据的哮喘数字自我管理平台的益处——单独使用时以及整合到已有的虚拟临床服务中时的益处。我们比较了一个数字自我管理项目加虚拟临床监督（称为治疗资源中心，DP + TRC）与仅数字自我管理（DP）项目在哮喘控制不佳患者中的六个月结果。DP包括电子药物传感器，可记录短效β受体激动剂（SABA）和控制药物使用的日期和时间。TRC包括远程护理监督，以促进吸入器依从性并应对症状恶化。使用回归模型对年龄、入组年份、控制药物/SABA使用情况和基线哮喘控制状态进行控制，回顾性评估SABA使用情况、控制药物依从性和项目留存率。评估了18584名DP患者（平均年龄（标准差）：33（14.6）岁；89.9%哮喘控制不佳）和3440名DP + TRC患者（平均年龄（标准差）：43.7（15.6）岁；48.6%控制不佳）。我们观察到，DP + TRC组与DP组相比，六个月项目留存率显著更高（55%对41%，p < 0.001），控制药物依从性也显著更高（54%对45%，p < 0.001），但平均SABA使用量无统计学显著差异（分别为平均每天0.76次与0.87次喷吸；p = 0.158）。从基线到六个月，两组的平均每日SABA使用量均有相似程度的减少（均p < 0.001），无SABA使用天数的百分比均有改善（均p < 0.001）。两组中控制药物依从性≥80%的患者比例均下降，但DP组相对于DP + TRC组的下降幅度更大。一个用于哮喘管理的数字自我管理平台与虚拟临床监督相结合，可能提供一种可扩展的解决方案，不仅能减少SABA使用，还能促进药物依从性并提高项目留存率。
