Emergency Department to Improve Pediatric Asthma Medicine Adherence

Rhode Island Hospital, Providence RI

Investigators

Linked publications, trials & patents

Abstract

? DESCRIPTION (provided by applicant): Asthma is the most common chronic illness in children and significantly impacts their health and quality- of-life. Asthma controller medications are effective at reducing asthma-related morbidity, but many families have low adherence with medication use. We propose a novel computer-based intervention in the emergency department (ED) setting to improve medication adherence for children 2-12 years-old with asthma. The first aim of this study is to use focus groups to develop the intervention by obtaining feedback from parents of children who have low adherence with asthma controller medications. In this series of focus groups, we will use participant feedback to finalize content items to be included in the Computerized Intervention Authoring Software (CIAS) that will be used in the intervention, and make the computerized interface appealing and acceptable to parents of children with asthma. The second aim of the study is to use a small randomized controlled trial to compare the CIAS intervention versus routine asthma care on asthma controller medicine adherence after an ED visit using a small randomized trial. Study participants in the CIAS (intervention) arm will complete a series of questions on a tablet computer. Questions will allow for creation of an individualized profile of medication and disease related knowledge, beliefs and practices for each participant The CIAS also allows for customized communication with each child's primary care provider. We will include educational boosters at 2 and 4 weeks after the intervention delivered via the medium chosen by the participant (email / text / RSS / mail) to sustain improvements in adherence. Children in the routine asthma care arm will not receive the CIAS intervention. We will compare groups by objective adherence measures using Doser CT devices on inhalers to measure daily administered doses of medicine. We will also measure relevant asthma-related clinical outcomes including asthma control, unscheduled health care use, and quality-of-life. We hypothesize that the intervention will improve the proportion of adherent days by 25% over in the intervention arm as compared to the control arm and improve asthma morbidity. In secondary analyses, we will test for an interaction effect based on important demographic and clinical factors, and determine whether adherence improvements are sustained over a period of 3 months. The significance of this study is that it will provide a novel reproducible computer-based intervention to improve adherence with asthma medications in a population of children known to have poor adherence. Our intervention is innovative because it is tailored to individuals, low-cost, disseminable, provides a mechanism for communicating with primary care providers, and uses tablet technology that is becoming more widespread in EDs. The data generated will be used to guide the development of the Responsive Education for Adherence with Controller Therapy (REACT) trial; a large planned randomized controlled trial of the intervention.