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Reminder system improved ICS adherence in children with asthma
Implementation of a speech recognition reminder system combined with an electronic health record improved adherence to inhaled corticosteroid among pediatric patients with asthma.
“Current evidence-based guidelines from the National Heart, Lung, and Blood Institute recommend that patients with persistent asthma receive daily controller medication, most often an inhaled corticosteroid (ICS),” Bruce G. Bender, PhD, from the division of pediatric behavioral health at National Jewish Health, and colleagues wrote. “However, most patients are markedly nonadherent with their prescribed ICS and half of patients fill an ICS prescription only once in 12 months.”
In an attempt to improve asthma medication adherence, without significant additional cost and labor, Bender and colleagues evaluated the efficacy of a program that integrated speech recognition software with electronic health records (EHRs) to deliver tailored reminders to patients when they were due to refill their ICS.
The researchers enrolled children (n = 1,187) aged 3 to 12 years with a persistent asthma diagnosis and prescription for an ICS, and they randomly assigned them to the computerized intervention or standard care.
The parents of patients in the computerized intervention received a speech recognition telephone call when the child’s ICS refill was due or overdue. Each call included medical and demographic information from the EHR to answer questions regarding:
- recent refills or a parent’s desire to receive help in refilling;
- more information about asthma control; or
- conversation with an asthma nurse or pharmacy staff member.
Patients were followed for up to 24 months between October 2009 and February 2013.
ICS adherence was 25.4% greater in the computerized intervention group (24-month mean adherence, 44.5% vs. 35.5%) than in the standard care group (P < .001).
The researchers observed that asthma-related urgent care events did not vary between groups. In addition, the effect of the intervention was found to be consistent in subgroups stratified by age, sex, race/ethnicity, BMI and disease-related characteristics.
“The significant improvement in adherence demonstrates strong potential for automated adherence interventions integrated within an EHR,” Bender and colleagues wrote. “Future research should focus on testing the intervention’s impact on clinical outcomes and costs in other settings and patient groups including adolescents and vulnerable populations.”
Disclosure: The researchers report no relevant financial disclosures.
