"Controlling Asthma" - A Mobile App Designed to Improve Patient Adherence
There are already hundreds of mobile apps that have been developed to help patients with asthma. However, as a recent review of many of these apps found, none has stood out as being effective enough for clinicians to routinely recommend its widespread use to assist in the management of their patients with persistent asthma. To meet this mark, an app has to include enough tools designed to overcome the obstacles of good adherence to make the time invested its use worthwhile. It is this all-too-common lack of adequate adherence to recommended therapies that often leads to the poor disease control and negative outcomes in patients with asthma, resulting in significant economic costs to society in terms of health care expenditures and lost productivity.
What are some of the common obstacles faced by patients and their families when trying to adhere to care providers' recommendations for managing their asthma?
Lack of ready access to reliable information about asthma when it is needed most. Important points from verbal education are forgotten, written hand-outs are lost, and the Internet is a quagmire. Patients/parents need reminders on:
- what asthma is
- what are its common manifestations (against which the patient's current symptoms can be compared)
- nonspecific triggers that make asthma worse
- triggers specific to the patient identified by previous allergy testing and the recommended avoidance measures
- which medications (generic and brand names, what they look like) are for quick relief and which are used for long-term control
- the correct techniques for using each medication
- the goals of asthma care
Lack of ready access to common tools needed for asthma care when it is needed most, for some of the same reasons:
- written asthma action plan from health care provider
contact information for health care provider/facility
Asthma Control Test to self-monitor symptoms
forms needed for school or daycare
The difficulty remembering to administer daily controller medications, especially when not symptomatic.
The difficulty busy parents have in monitoring their older children’s adherence, especially when that adherence is incomplete (which is always the case). Even with the counters now available on most metered dose inhalers used with controller medications, how can a parent periodically assess the degree of adherence by looking at the counter at a particular point in time after that inhaler had been started?
The difficulty in obtaining refills on medications, especially chronic controller medications.
the prescription number and refill pharmacy phone number are on the label affixed to the outside box that holds the inhalers, which is inevitably discarded when the medication is first opened; this leads to the necessity of calling the provider’s office to request new prescriptions to be placed or of making an appointment to get a new prescription
not having ready access to contact numbers and the hours of the pharmacies, particularly the off-peak evening and weekend hours, when missing work, having difficulty finding parking and long waits can be avoided
Not knowing when rescue medications are about to run out or expire, leading to their lack of availability when needed. Patients/families often forget to bring in their medications during office visits for review, leading to requests for additional inhalers when not necessary or failure to request them when actually needed. Medication reconciliation print-outs are notoriously inaccurate and therefore unreliable for this purpose.
Not having confidence in the health care system to provide adequately cohesive continuity of care, leading to mistrust in the treatment recommendations given. Factors that impede the accurate tracking of each patient’s asthma history and status include:
a cumbersome electronic medical record system that makes it too time-consuming for busy primary care providers to track prior lung function testing or allergy testing or access key details regarding prior ER visits or hospitalizations for asthma exacerbations or to look for the existence of more than one record for a single patient
inadequate integration of records when patients are referred to network for specialty evaluation or when they have to access emergency care at another health care facility not within the same health care system
inadequate reminders of upcoming appointments or need to make recommended follow-up appointments
With the development of this mobile app, we aim to address each of these obstacles with tools to enable patients and families, working in conjunction with their care providers, to efficiently and effectively overcome them, thereby improving the adherence that is needed for better outcomes and cost control in asthma care. We plan to develop the app so that it can be used across the different operating platforms to encourage widespread use. We envision the establishment of standard procedures to make it easy for users to upload their data to the app, as well as being able to generate reports that would be clinically useful for their care providers.