Commentary

Evidence-Based Apps: Texting reminders improved pediatric asthma control


 

A small study presented at the American Academy of Allergy, Asthma, and Immunology meeting in San Diego adds to a growing body of evidence that texting patients reminders to take their medication may improve asthma control.

Dr. Humaa M. Bhatti’s ongoing study is one of the few so far to look not just at medication adherence but at health outcomes. But, like similar studies before it, the trial’s small size and short duration so far preclude any definitive pronouncements about the effectiveness of using text messages (also known as short message service) via mobile phones to influence patient behavior. A couple of recent reviews of the literature, however, show mostly positive results.

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Starting in April 2013, Dr. Bhatti and her associates recruited 37 patients up to 18 years of age with asthma to receive twice-daily texts from a research assistant reminding them to take medication. Texts went to the parents of children and/or directly to the adolescents. Patients or parents also could reply to communicate with the research assistant.

For the 29 patients who received 3-9 months of texting at the time of preliminary analysis of results (8 patients dropped out), records showed that 21 patients had two or more steroid bursts in the 12 months prior to the start of texting (72%), 28 had at least one urgent visit (96%) in that year, and 28 had been hospitalized for asthma at least once (96%).

Courtesy Wikimedia Commons/BuzzFarmer/Creative Commons license

Receiving texted medication reminders improved asthma control in children and teens.

The number of asthma exacerbations requiring prednisone decreased from a mean of 3.4/patient before the trial to 1.6/patient with texted reminders. Hospitalizations decreased from a mean of 1.6/patient before the trial to 0.8/patient. Urgent or emergency visits decreased from a mean of 3/patient before the trial to 1.4/patient. Those differences were statistically significant, reported Dr. Bhatti, an allergy and immunology fellow at the Children’s Hospital of Michigan, Detroit.

Since the texting started, 16 of the 29 patients (55%) had no steroid bursts, emergency department visits, or hospitalizations. Similar results were seen for 25 patients who were added to the study since November 2013, a preliminary analysis found.

The study soon will open to all patients with asthma at the hospital to see if results remain positive and are sustained over longer periods. With more patients to text, the investigators are considering using an automated text-sending program that would not allow the recipients to reply, and patients may be randomized to receive texts from either the research assistant or the text program to see if there is a difference in outcomes.

A separate systematic review of the literature found five randomized controlled trials and one "pragmatic" randomized controlled trial reporting evidence that daily technology-based reminders improved asthma medication adherence. None of these trials documented improved clinical outcomes or changes in asthma-related quality of life. The reminder systems studied included text messages, automated phone calls, or audiovisual reminder devices. The median follow-up time was 16 weeks (J. Asthma 2014 Feb. 13 [doi: 10.3109/02770903.2014.888572]).

Dr. Humaa M. Bhatti

Texting also looked good in another literature review that found 13 controlled clinical trials of interventions using text messages, audiovisual reminders from electronic reminder devices, or pagers for patients on chronic medication. Of the four studies using texting, medication adherence improved in the one study of asthma and in two studies of HIV, but made no difference in one study of women on oral contraceptives (J. Am. Med. Inform. Assoc. 2012 [doi: 10.1136/amiajnl-2011-00748]). The one study on patients with asthma in that review was, again, a small, short study of 26 adults. Adherence to treatment improved after 12 weeks by an absolute rate of 18% in the texting group compared with controls (Respir. Med. 2010;104:166-71).

There are hints elsewhere that texting may not always help. At the 2011 meeting of the American Academy of Allergy, Asthma and Immunology, Dr. Jennifer S. Lee reported that two of seven patients aged 6-17 years improved their asthma control after receiving text message reminders. Texting influenced children but not adolescents, according to news interviews with Dr. Lee, an allergist and ear, nose, and throat specialist in Brooklyn, N.Y.

Dr. Bhatti had no financial disclosures.

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