Going mobile with primary care: smartphone-telemedicine for asthma management in young urban adults (TEAMS)

The majority of adults with persistent asthma have chronically uncontrolled disease and interventions to improve outcomes are needed. We evaluated the efficacy, feasibility, and acceptability of a multi-component smartphone-telemedicine program (TEAMS) to deliver asthma care remotely, support provider adherence to asthma management guidelines, and improve patient outcomes. TEAMS utilized: (1) remote symptom monitoring, (2) nurse-led smartphone-telemedicine with self-management training for patients, and (3) Electronic medical record-based clinical decision support software. Adults aged 18-44 (N = 33) and primary care providers (N = 4) were recruited from a safety-net practice in Upstate New York. Asthma control, quality of life, and FEV1 were measured at 0, 3 and 6 months. Acceptability was assessed via survey and end-of-study interviews. Paired t-test and mixed effects modeling were used to evaluate the effect of the intervention on asthma outcomes. At baseline, 80% of participants had uncontrolled asthma. By 6-months, 80% classified as well-controlled. Improvements in control and quality of life were large (d = 1.955, d = 1.579). FEV%pred increased 4.2% (d = 1.687) with the greatest gain in males, smokers, and lower educational status. Provider adherence to national guidelines increased from 43.3% to 86.7% (CI = 22.11-64.55) and patient adherence to medication increased from 45.58% to 85.29% (CI = 14.79-64.62). Acceptability was 95.7%; In follow up interviews, 29/30 patients and all providers indicated TEAMS worked better than usual care, supported effective self-management, and reduced symptoms over time, which led to greater self-efficacy and motivation to manage asthma. Based on these findings, we conclude that smartphone telemedicine could substantially improve clinical asthma management, adherence to guidelines, and patient outcomes.

多数持续性哮喘成人患者仍处于长期未得到有效控制的疾病状态，亟需可改善临床转归的干预方案。本研究评估了一款多组分智能手机远程医疗项目（TEAMS）的疗效、可行性与可接受性，该项目旨在通过远程方式提供哮喘照护，助力医疗服务人员遵循哮喘管理指南，并改善患者临床结局。TEAMS包含三大核心模块：（1）远程症状监测；（2）由护士主导的智能手机远程医疗服务，配套患者自我管理培训课程；（3）基于电子病历的临床决策支持软件。本研究从纽约州北部一家安全网医疗服务机构，招募了33名18~44岁的成人哮喘患者与4名初级医疗服务提供者。研究分别于基线（0个月）、3个月及6个月时，评估受试者的哮喘控制情况、生活质量及一秒用力呼气容积（FEV1）；并通过问卷调查与研究末期访谈，评估受试者对该项目的可接受性。本研究采用配对t检验与混合效应模型，评估该干预措施对哮喘临床结局的影响。基线时，80%的受试者哮喘未得到有效控制；至干预6个月后，80%的受试者哮喘达到良好控制水平。受试者的哮喘控制情况与生活质量均得到显著改善，效应量d分别为1.955与1.579。一秒用力呼气容积占预计值百分比（FEV1%pred）提升了4.2%，效应量d为1.687；其中男性、吸烟者及受教育程度较低的受试者获益最为显著。医疗服务人员对国家级哮喘管理指南的依从性从43.3%提升至86.7%（95%置信区间CI=22.11~64.55）；患者的药物治疗依从性从45.58%提升至85.29%（CI=14.79~64.62）。该项目的整体可接受率为95.7%；后续访谈结果显示，30名患者中的29名与全部医疗服务提供者均认为，TEAMS项目优于常规照护模式，可助力患者实现有效的自我管理，随时间推移缓解症状，并进而提升患者的哮喘自我管理效能与管理动机。基于上述研究结果，本研究认为智能手机远程医疗可显著优化哮喘临床照护质量、提升指南依从性，并改善患者临床结局。