IIR 01-054 – HSR&D Study
Career Development Projects
Effectiveness of a Telecommunications System in Asthma Management
David William Sparrow DSc
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
April 2004 -
Asthma is one of the most common chronic diseases of adults, affecting 6% of the U.S. adult population and accounting for substantial morbidity and mortality. Despite the availability of effective therapy for asthma, morbidity and mortality have increased over the last several decades. Asthma specialty care, case management, and patient education are means for improving the quality of asthma care and patient outcomes, but cost and inconvenience limit the degree to which these are used in asthma care nationally. The principal aim of this study is to evaluate the impact of an inexpensive telephone-based home education and disease monitoring system on asthma medication adherence and clinical outcomes in adult patients with asthma.
We hypothesize that application of a Telephone-Linked Communications (TLC) system to the care of adult patients with asthma (TLC-Asthma) will improve self-management by enhancing compliance with preventive medication regimens and fostering the use of peak flow-based action plans. This, in turn, will improve asthma control and quality of life (QOL).
A randomized controlled trial has been conducted with adult asthma patients identified from the VA Boston Healthcare System comprised of the Boston, West Roxbury, and Brockton VA Medical Centers and their associated satellite clinics. Patients were randomized to either the TLC-Asthma group or an attention placebo control group. TLC-Asthma monitors a patient's adherence to prescribed asthma medications and offers education and counseling appropriate to the patient's level of adherence.
An analysis of 115 adults with asthma (56 randomized to TLC-Asthma, 59 randomized to attention placebo control group) has been completed. Analyses were performed using an intent-to-treat approach. Baseline characteristics of the intervention and control groups were comparable. During follow-up these groups were compared on medication adherence as assessed by canister weighing and pill counts. Generalized estimating equations (GEE) were used to examine the difference between medication adherence for subjects in the TLC-Asthma and control groups. There was no significant difference found between the intervention and control groups on medication adherence. Similarly, the groups did not differ significantly with regard to asthma-related QOL. Subjects in the TLC-Asthma group had a non-significantly lower occurrence of exacerbations than subjects in the control group.
Ongoing Telephone-Linked Communications (TLC) systems offer a low-cost and easy-to-use means of providing ongoing education, behavioral counseling, and monitoring of clinical status.
None at this time.