PURPOSE OF THE STUDY.
To test whether a speech recognition (SR) intervention leads to improved adherence with taking controller medications for asthma.
There were 1187 children, aged 3 to 12 years, with a diagnosis of persistent asthma and a prescription for an inhaled corticosteroid. This population was drawn from Kaiser Permanente Colorado, which is a large group-model health maintenance organization.
The trial was 24 months in duration. Subjects were randomized to the computerized SR intervention or usual care. For the intervention group, SR telephone calls were made to the subjects’ parents when an inhaled corticosteroid refill was due or overdue. These calls were individually tailored using medical and demographic information from the medical record and parent’s answers to questions regarding desire to receive reminders, information about asthma, and other support. The main outcome measure was adherence to controller medications, measured as the possession ratio of medication over 24 months.
In the intention-to-treat analysis, adherence with inhaled corticosteroids was 25.4% higher in the intervention group than in the usual care group (24-month mean adherence 44.5% vs 35.5%, respectively; P < .001). The effect of the intervention was consistent in subgroups divided by age, gender, ethnicity, BMI, and disease-related characteristics. Interestingly, asthma-related urgent care visits did not differ between the 2 groups.
The intervention’s significant impact on adherence demonstrates strong potential for low-cost adherence programs using SR and electronic health records. The authors also concluded that the absence of change in urgent care visits may be related to the already low number of asthma urgent care visits in patients in their health maintenance organization.
Although the adherence rate in both groups was disappointingly low, a 25.4% rise in adherence, across a population, can equate to tremendous cost savings in asthma management along with reduced burden of disease. Other metrics, aside from urgent care visits, may have shown improvements commensurate with the increased rate of adherence. I am intrigued to see another mechanism through which EMR can be leveraged to help large groups of people.
- Copyright © 2015 by the American Academy of Pediatrics