Can the Internet Control Your Patients' Asthma?
Abstract & Commentary
By Rahul Gupta, MD, MPH, FACP, Assistant Professor, Department of Medicine, Meharry Medical College; Assistant Clinical Professor, Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN. Dr. Gupta reports no financial relationship to this field of study.
Synopsis: Internet-based self-management resulted in improvements in asthma control and lung function with resultant increases in the number of symptom-free days. However, this did not significantly reduce exacerbation rates.
Source: van der Meer V, et al. Internet-based self-management plus education compared with usual care in asthma: A randomized trial. Ann Intern Med 2009;151:110-120.
The most recent national asthma education and prevention program reports that asthma affects more than 22 million persons in the United States.1 While the improved recognition of asthma in young children may be contributing to the rising prevalence rates, hospitalization rates have remained relatively stable over the last decade. Therefore, both national and international guidelines have concluded that a successful asthma management program must include four essential components1,2: 1) routine assessment and monitoring of symptom control and lung function; 2) patient education to create a partnership between clinician and patient; 3) control of environmental factors (triggers) and comorbid conditions that contribute to asthma severity; and 4) pharmacologic therapy.
Studies have reported that despite the availability of monitoring tools and effective therapy, asthma control is suboptimal in many patients worldwide, and long-term management falls far short of the goals set in the guidelines.3 Therefore, asthma management guidelines recommend the ongoing periodic assessments of symptoms and monitoring of asthma control to determine if the goals of therapy are being met and if adjustments to therapy are needed. In this process, the clinician assessment and patient self-assessment are identified as primary methods for monitoring asthma. As a result of a substantial number of studies in the field, the guidelines also recommend that whether peak flow monitoring, symptom monitoring, or a combination of approaches is used, self-monitoring is important to the effective self-management of asthma.
In the current study, van der Meer et al utilized the internet technology to evaluate whether a self-guided asthma management tool for adults with asthma could be an effective option for long-term control of this chronic disease. This was a 12-month, multicenter, nonblinded, randomized control trial with a total of 200 adult asthmatic patients recruited across 37 general practices in Netherlands. Patients on maintenance oral steroids were excluded. After providing basic information on asthma, daily FEV1 measurements and medications, patients were randomly assigned to either the Internet group (n = 101) or the usual care group (n = 99). The Internet-based self-management program included weekly asthma control monitoring and treatment plan, on-line and group education, and remote web communications with a specialized asthma nurse.
The researchers found that asthma-related quality of life and asthma control improved more in the Internet group than in the usual care group (P < 0.001). At 12 months, 63% of Internet patients and 52% of usual care patients reported symptom-free days in the previous 2 weeks (adjusted absolute difference, 10.9%; confidence interval [CI], 0.05%-21.3%). Prebronchodilator FEV1 changed by 0.24 L and -0.01 L (adjusted difference, 0.25 L; CI, 0.03-0.47 L) for the Internet and usual care groups, respectively. There was no statistical difference in asthma exacerbations between the two groups.
Commentary
The study suggests that Internet-based self-management of asthma improves quality of life, asthma control, and lung function, and increases the number of symptom-free days compared with the usual physician-provided care. The broader use of web-based resources has the potential to enable a dramatic transformation in the delivery of health care, making it safer, more effective, and more efficient. However, questions remain about how best to use existing technologies, deploy new ones, and evaluate the effects. I believe the management of chronic diseases is one such area where major gains can be achieved swiftly. One of the missing pieces in chronic disease management programs has been an effective way to disseminate knowledge to patients. Another has been a successful tool that can empower patients to achieve and maintain control of their diseases such as asthma, hypertension, obesity, and diabetes. While current research data have shown that process benefits are easier to achieve than outcomes benefits through information technology, much research in this field is still lacking.4 However, as the national health care reform dialogue evolves, we must recognize that a significant proportion of the medical expenditure in the United States is used to manage chronic disease complications. Such costs are sure to become unsustainable unless we find ways to prevent and/or manage chronic diseases, and in so doing reduce the complications. Appropriately utilizing information technology in this area is essential to accomplishing this goal.
References
1. National Asthma Education and Prevention Program. Guidelines for the diagnosis and management of asthma: Expert panel report 3. Bethesda, MD: National Institutes of Health; 2007. Available at: www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. Accessed Aug. 11, 2009.
2. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Bethesda, MD: National Institutes of Health; 1995. NIH publication No. 02-3659.
3. Rabe KF, et al. Worldwide severity and control of asthma in children and adults: The global asthma insights and reality surveys. J Allergy Clin Immunol 2004; 114:40-47.
4. Einbinder JS, Bates DW. Leveraging information technology to improve quality and safety. Yearb Med Inform 2007:22-29.
Internet-based self-management resulted in improvements in asthma control and lung function with resultant increases in the number of symptom-free days. However, this did not significantly reduce exacerbation rates.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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