Published online March 1, 2007
PEDIATRICS Vol. 119 No. 3 March 2007, pp. 569-578 (doi:10.1542/10.1542/peds.2006-1884)
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SPECIAL ARTICLE

Internet-Based Home Monitoring and Education of Children With Asthma Is Comparable to Ideal Office-Based Care: Results of a 1-Year Asthma In-Home Monitoring Trial

Debora S. Chan, PharmD, FASHP, Charles W. Callahan, DO, Virginia B. Hatch-Pigott, MD, Annette Lawless, RN, H. Lorraine Proffitt, RN, Nola E. Manning, RN, Mary Schweikert, RN and Francis J. Malone, MD{dagger}

Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii

OBJECTIVE. The goal was to determine whether home asthma telemonitoring with store-and-forward technology improved outcomes, compared with in-person, office-based visits.

METHODS. A total of 120 patients, 6 to 17 years of age, with persistent asthma were assigned randomly to the office-based or virtual group. The 2 groups followed the same ambulatory clinical pathway for 12 months. Office-based group patients received traditional in-person education and case management. Virtual group patients received computers, Internet connections, and in-home, Internet-based case management and received education through the study Web site. Disease control outcome measures included quality of life, utilization of services, and symptom control.

RESULTS. A total of 120 volunteers (45 female) were enrolled. The groups were clinically comparable (office-based: 22 female/38 male; mean age: 9.0 ± 3.0 years; virtual: 23 female/37 male; mean age: 10.2 ± 3.1 years). Virtual patients had higher metered-dose inhaler with valved holding chamber technique scores than did the office-based group at 52 weeks (94% vs 89%), had greater adherence to daily asthma symptom diary submission (35.4% vs 20.8%), had less participant time (636 vs 713 patient-months), and were older. Caregivers in both groups perceived an increase in quality of life and an increase in asthma knowledge scores from baseline. There were no other differences in therapeutic or disease control outcome measures.

CONCLUSIONS. Virtual group patients achieved excellent asthma therapeutic and disease control outcomes. Compared with those who received standardized office-based care, they were more adherent to diary submission and had better inhaler scores at 52 weeks. Store-and-forward telemedicine technology and case management provide additional tools to assist in the management of children with persistent asthma.

Key Words: telemedicine • home • telehealth • telemonitoring • store-and-forward • clinic • case management • pediatric

Abbreviations: DPI—dry-powder inhaler • MDI-VHC—metered-dose inhaler with valved holding chamber

Accepted Oct 30, 2006.


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