Abstract
Importance: Most patients with asthma take fewer than half of prescribed doses of controller medication. Interventions to improve adherence have typically been costly, impractical, and at best only minimally successful. Objective: To test a speech recognition (SR) intervention to improve adherence to pediatric asthma controller medication. Design, Setting, And Participants: The BreatheWell studywas a 24-month pragmatic randomized clinical trial. The study was conducted within Kaiser Permanente Colorado, a large, group-model health maintenance organization. A total of 1187 children aged 3 to 12 years with a persistent asthma diagnosis and prescription for an inhaled corticosteroid were randomized to the computerized SR intervention or usual care condition and followed up for 24 months between October 2009 and February 2013. Interventions: Speech recognition telephone calls to parents in the intervention condition were triggered when an inhaled corticosteroid refill was due or overdue. Calls were automatically tailored with medical and demographic information from the electronic health record and from parent answers to questions in the call regarding recent refills or a desire to receive help refilling, learn more about asthma control, or speak with an asthma nurse or pharmacy staff member. Main Outcomes And Measures: Adherence to pediatric asthma controller medication, measured as the medication possession ratio over 24 months. Results: In the intention-to-treat analysis, inhaled corticosteroid adherence was 25.4% higher in the intervention group than in the usual care group (24-month mean [SE] adherence, 44.5%[1.2%] vs 35.5%[1.1%], respectively; P <.001). Asthma-related urgent care events did not differ between the 2 groups. The intervention effect was consistent in subgroups stratified by age, sex, race/ethnicity, body mass index, and disease-related characteristics. Conclusions And Relevance: The intervention's significant impact on adherence demonstrates strong potential for low-cost SR adherence programs integrated with an electronic health record. The absence of change in urgent care visits may be attributable to the already low number of asthma urgent care visits within Kaiser Permanente Colorado. Application of electronic health record-leveraged SR interventions may reduce health care utilization when applied in a population with less-controlled asthma. Trial Registration: clinicaltrials.gov Identifier: NCT00958932.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 317-323 |
| Number of pages | 7 |
| Journal | JAMA Pediatrics |
| Volume | 169 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2015 |
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ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Medicine(all)
Cite this
Pragmatic trial of health care technologies to improve adherence to pediatric asthma treatment a randomized clinical trial. / Bender, Bruce G.; Cvietusa, Peter J.; Goodrich, Glenn K.; Lowe, Ryan; Nuanes, Heather A.; Rand, Cynthia S; Shetterly, Susan; Tacinas, Cathy; Vollmer, William M.; Wagner, Nicole; Wamboldt, Frederick S.; Xu, Stanley; Magid, David J.
In: JAMA Pediatrics, Vol. 169, No. 4, 01.04.2015, p. 317-323.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Pragmatic trial of health care technologies to improve adherence to pediatric asthma treatment a randomized clinical trial
AU - Bender, Bruce G.
AU - Cvietusa, Peter J.
AU - Goodrich, Glenn K.
AU - Lowe, Ryan
AU - Nuanes, Heather A.
AU - Rand, Cynthia S
AU - Shetterly, Susan
AU - Tacinas, Cathy
AU - Vollmer, William M.
AU - Wagner, Nicole
AU - Wamboldt, Frederick S.
AU - Xu, Stanley
AU - Magid, David J.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Importance: Most patients with asthma take fewer than half of prescribed doses of controller medication. Interventions to improve adherence have typically been costly, impractical, and at best only minimally successful. Objective: To test a speech recognition (SR) intervention to improve adherence to pediatric asthma controller medication. Design, Setting, And Participants: The BreatheWell studywas a 24-month pragmatic randomized clinical trial. The study was conducted within Kaiser Permanente Colorado, a large, group-model health maintenance organization. A total of 1187 children aged 3 to 12 years with a persistent asthma diagnosis and prescription for an inhaled corticosteroid were randomized to the computerized SR intervention or usual care condition and followed up for 24 months between October 2009 and February 2013. Interventions: Speech recognition telephone calls to parents in the intervention condition were triggered when an inhaled corticosteroid refill was due or overdue. Calls were automatically tailored with medical and demographic information from the electronic health record and from parent answers to questions in the call regarding recent refills or a desire to receive help refilling, learn more about asthma control, or speak with an asthma nurse or pharmacy staff member. Main Outcomes And Measures: Adherence to pediatric asthma controller medication, measured as the medication possession ratio over 24 months. Results: In the intention-to-treat analysis, inhaled corticosteroid adherence was 25.4% higher in the intervention group than in the usual care group (24-month mean [SE] adherence, 44.5%[1.2%] vs 35.5%[1.1%], respectively; P <.001). Asthma-related urgent care events did not differ between the 2 groups. The intervention effect was consistent in subgroups stratified by age, sex, race/ethnicity, body mass index, and disease-related characteristics. Conclusions And Relevance: The intervention's significant impact on adherence demonstrates strong potential for low-cost SR adherence programs integrated with an electronic health record. The absence of change in urgent care visits may be attributable to the already low number of asthma urgent care visits within Kaiser Permanente Colorado. Application of electronic health record-leveraged SR interventions may reduce health care utilization when applied in a population with less-controlled asthma. Trial Registration: clinicaltrials.gov Identifier: NCT00958932.
AB - Importance: Most patients with asthma take fewer than half of prescribed doses of controller medication. Interventions to improve adherence have typically been costly, impractical, and at best only minimally successful. Objective: To test a speech recognition (SR) intervention to improve adherence to pediatric asthma controller medication. Design, Setting, And Participants: The BreatheWell studywas a 24-month pragmatic randomized clinical trial. The study was conducted within Kaiser Permanente Colorado, a large, group-model health maintenance organization. A total of 1187 children aged 3 to 12 years with a persistent asthma diagnosis and prescription for an inhaled corticosteroid were randomized to the computerized SR intervention or usual care condition and followed up for 24 months between October 2009 and February 2013. Interventions: Speech recognition telephone calls to parents in the intervention condition were triggered when an inhaled corticosteroid refill was due or overdue. Calls were automatically tailored with medical and demographic information from the electronic health record and from parent answers to questions in the call regarding recent refills or a desire to receive help refilling, learn more about asthma control, or speak with an asthma nurse or pharmacy staff member. Main Outcomes And Measures: Adherence to pediatric asthma controller medication, measured as the medication possession ratio over 24 months. Results: In the intention-to-treat analysis, inhaled corticosteroid adherence was 25.4% higher in the intervention group than in the usual care group (24-month mean [SE] adherence, 44.5%[1.2%] vs 35.5%[1.1%], respectively; P <.001). Asthma-related urgent care events did not differ between the 2 groups. The intervention effect was consistent in subgroups stratified by age, sex, race/ethnicity, body mass index, and disease-related characteristics. Conclusions And Relevance: The intervention's significant impact on adherence demonstrates strong potential for low-cost SR adherence programs integrated with an electronic health record. The absence of change in urgent care visits may be attributable to the already low number of asthma urgent care visits within Kaiser Permanente Colorado. Application of electronic health record-leveraged SR interventions may reduce health care utilization when applied in a population with less-controlled asthma. Trial Registration: clinicaltrials.gov Identifier: NCT00958932.
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U2 - 10.1001/jamapediatrics.2014.3280
DO - 10.1001/jamapediatrics.2014.3280
M3 - Article
C2 - 25664620
AN - SCOPUS:84928264747
VL - 169
SP - 317
EP - 323
JO - JAMA Pediatrics
JF - JAMA Pediatrics
SN - 2168-6203
IS - 4
ER -