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mHealth Gives Doctors Insight Into Medication Management at Home

A recent study found that people living with asthma are not using their inhalers correctly. One of the doctors involved in that study explains how mHealth can help patients and providers follow the rules.

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By Eric Wicklund

- mHealth programs targeting medication management for people living with chronic diseases often focus on the costs of missed doses or unfilled prescriptions. But connected care platforms also have value in making sure patients aren’t misusing their medications.

An ideal example is in remote care management for people with asthma. Providers who use mHealth and telehealth to monitor their patients at home are finding that the platform can help them identify and work with patients who aren’t using their inhalers properly.

It’s a big issue. According to a survey by Propeller Health, one of the leading developers of digital health platforms for asthma care management, 84 percent of those surveyed aren’t using their inhalers correctly, making the medication less effective and increasing the risk of more damaging health outcomes down the road.

According to the study, patients are usually required to take two puffs from an inhaler to receive the prescribed amount of medication. Guidelines call for the patient to exhale completely, take a puff from the inhaler, hold one’s breath for as much as 10 seconds, wait a little while longer, then take a second puff, about 30 seconds after the first.

But the study found that most patients took less than 30 seconds between puffs, with two-thirds waiting less than 15 seconds.

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"Doctors have known for years that many patients do not follow the recommended inhaler instructions,” David Stempel, MD, Propeller's senior vice president of medical and clinical affairs, said in a press release. “This is the first time we've had objective data from digital medicines to observe it outside of the clinic."

"Digital medicines have the potential to not only assess inhaler technique in real-time but also notify a patient when they're not using the inhaler properly and provide education and sources for training, which goes beyond what a clinician can do for the patient day-to-day,” he added.

The study, involving more than 7,500 patients living with asthma who use digital health tools to help manage their care at home, was conducted by researchers at the University of Colorado School of Medicine and Children's Hospital Colorado. Their research was published this past February in the Journal of Allergy and Clinical Immunology.

Among those conducting the research was Stanley Szefler, MD, director of the Pediatric Asthma Research Program in the Breathing Institute of the Pediatric Pulmonary and Sleep Medicine Section at Children's Hospital Colorado. He sat down recently with mHealthIntelligence.com to talk about how care providers can use mHealth technology to address this issue.

Q. Are the results of this study surprising to you? Why or why not?

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A. Clinicians have always known that patients struggle to use their inhalers properly, but collecting this data in real-time with a digital medicine is completely novel. Prior to digital medicines, the clinician was dependent on asking the patient during their appointments to demonstrate their inhaler technique, which could bias the results. With digital medicines, we have the ability to assess a patient’s inhaler technique in real time and potentially provide feedback to help them adhere to proper technique.

Q. How can mHealth technology help you to solve this problem, and improve care management?

A. Digital medicines can help patients with their inhaler technique by assessing their technique and providing education and small “nudges” to correct it as necessary. In the same way that smartphone notifications help patients remember to take their medicine (which was proven in a previous study), technique reminders can help patients remember the instructions for using their inhaler and adhere to them.

These reminders go beyond what a clinician can do in their office visits, as clinicians only see their patients every so often and can’t be there every day to monitor their technique.

Q. Without such technology, how do you go about trying to educate patients on care management at home?

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A. Without digital medicines, education on inhaler technique largely takes place in the clinic, which limits the clinician’s ability to monitor and correct the patient’s technique. Part of the benefit of digital medicines is that they have the potential to correct patient behavior in real-time, providing education to patients who are uninformed and a small “nudge” to those whose technique has lapsed.

Q. What are the downhill effects of this type of problem - what happens when inhalers are used incorrectly?

A. Research has shown that incorrect controller inhaler technique is associated with poorer asthma control -- in other words, more symptoms and exacerbations -- and more prescriptions for rescue medication. Using an inhaler correctly helps patients achieve the intent of the medication, which is to reduce or relieve symptoms, prevent exacerbations and avoid unnecessary hospitalization.

Q. What other types of mobile health or digital health technology might be useful here?

A. Our group is very interested in applying technology to advance asthma care. There are a number of items we are evaluating to improve communication among patients and healthcare providers. We are also exploring ways to use technology to indicate early warning signs of an asthma attack in order to intervene appropriately.

Q. How should this program evolve to improve care management in the future?

A. To improve care management, we need to get digital medicines into the hands of patients and doctors and start the transition toward the digital management of care.

Q. What are the biggest barriers or challenges in using this technology with patients?

A. As with any new technology, the biggest barrier is helping patients understand how this will change their experience of chronic respiratory disease, and then getting them started on the program. Once patients see the benefit of a digital medicine in helping them remember their medication, understand their symptoms and avoid exacerbations, they buy in whole-heartedly.

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