Pragmatic trial of health care technologies to improve adherence to pediatric asthma treatment a randomized clinical trial

Bruce G. Bender, Peter J. Cvietusa, Glenn K. Goodrich, Ryan Lowe, Heather A. Nuanes, Cynthia S Rand, Susan Shetterly, Cathy Tacinas, William M. Vollmer, Nicole Wagner, Frederick S. Wamboldt, Stanley Xu, David J. Magid

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)317-323
Number of pages7
JournalJAMA Pediatrics
Volume169
Issue number4
DOIs
StatePublished - Apr 1 2015

Fingerprint

Pragmatic Clinical Trials
Biomedical Technology
Asthma
Randomized Controlled Trials
Pediatrics
Electronic Health Records
Ambulatory Care
Adrenal Cortex Hormones
Therapeutics
Patient Acceptance of Health Care
Intention to Treat Analysis
Health Maintenance Organizations
Telephone
Prescriptions
Body Mass Index
Parents
Nurses
Demography
Outcome Assessment (Health Care)

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 journalArticle

Bender, BG, Cvietusa, PJ, Goodrich, GK, Lowe, R, Nuanes, HA, Rand, CS, Shetterly, S, Tacinas, C, Vollmer, WM, Wagner, N, Wamboldt, FS, Xu, S & Magid, DJ 2015, 'Pragmatic trial of health care technologies to improve adherence to pediatric asthma treatment a randomized clinical trial', JAMA Pediatrics, vol. 169, no. 4, pp. 317-323. https://doi.org/10.1001/jamapediatrics.2014.3280
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. / Pragmatic trial of health care technologies to improve adherence to pediatric asthma treatment a randomized clinical trial. In: JAMA Pediatrics. 2015 ; Vol. 169, No. 4. pp. 317-323.
@article{f55f7becd5eb410e975def9ebd89ceea,
title = "Pragmatic trial of health care technologies to improve adherence to pediatric asthma treatment a randomized clinical trial",
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.",
author = "Bender, {Bruce G.} and Cvietusa, {Peter J.} and Goodrich, {Glenn K.} and Ryan Lowe and Nuanes, {Heather A.} and Rand, {Cynthia S} and Susan Shetterly and Cathy Tacinas and Vollmer, {William M.} and Nicole Wagner and Wamboldt, {Frederick S.} and Stanley Xu and Magid, {David J.}",
year = "2015",
month = "4",
day = "1",
doi = "10.1001/jamapediatrics.2014.3280",
language = "English (US)",
volume = "169",
pages = "317--323",
journal = "JAMA Pediatrics",
issn = "2168-6203",
publisher = "American Medical Association",
number = "4",

}

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.

UR - http://www.scopus.com/inward/record.url?scp=84928264747&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84928264747&partnerID=8YFLogxK

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 -