Vice Chair, Department of Pediatrics Sinai Hospital Georgetown University School of Medicine Baltimore, Maryland, United States
Background: Despite new treatments and guideline-based care, asthma remains a significant public health problem that disproportionately affects minorities and socioeconomically disadvantaged children. Medical care, missed school, and missed work related to asthma cost the health care system more than $80 billion each year. Up to 40-50% of patients are challenged by improper technique and adherence to controller medications which contribute to suboptimal care. We sought to determine the feasibility of remote video observed therapy through a phone app in a socioeconomically disadvantaged community in West Baltimore.
Objective: To determine the feasibility of a video direct observed therapy (vDOT) for asthma controller medications in an underserved population.
Design/Methods: We collaborated with eMocha Health Solutions to create an app that would allow patients to download videos of administering controller therapy that would be viewed by trained personnel. We enrolled patients at Greenspring Pediatric Associates at Sinai Hospital from February - March 2020 for a 60 day pilot. Inclusion criteria included: patient aged 2-18 with a diagnosis of persistent asthma and either a recent hospitalization, non-compliance with medication regimen, frequent albuterol refills /use of rescue inhaler, care escalation, or a positive ACT.
Results: The program was introduced to 26 patients by a doctor on-site and 24 patients enrolled (92%), including 8 females and 16 males and mean age of 10.2 years. Throughout the 60-day program, 75% of families participated for at least 30 days. Of the 874 virtual medication videos, 331 (38%) were flagged as having issues. 96% of issues were handled remotely by the nurse (252 were technique issues) and 11 situations were escalated to clinic doctors. Patients who remained engaged in the program for 60 days completed at least one virtual medication appointment per day. 7 patients submitted at least one video per day for 90% of the days and one patient was 100% adherent throughout the program. Adherence details by patient are described in Table 1 and Figures 1 and 2. Table 2 highlights the barriers to adherence by participant noted in the video reviews. Conclusion(s): Use of the eMocha platform was acceptable and feasible for patients. More than 250 inhaler technique errors were identified and fixed and most patients participated for at least 30 days. This clinical tool may be yet another option to help improve technique and adherence in patients who need to use asthma controller medications.
Authors/Institutions: Scott D. Krugman, Sinai Hospital, Baltimore, Maryland, United States; Barbara Weis, Sinai Hospital, Baltimore, Maryland, United States; Lindsay L. Ye, emocha, Baltimore, Maryland, United States