Clinically-enhanced digital health program for respiratory care associated with better medication use and retention

Digital health platforms for asthma self-management have demonstrated promise in improving clinical and quality of life outcomes. However, few studies have examined such an approach in a real-world, fully remote setting. As such, we evaluated the benefit of an evidence-based digital self-management platform for asthma-both on its own and when integrated into an established virtual clinical service. We compared six-month outcomes of a digital self-management program plus virtual clinical oversight, called a therapeutic resource center, (DP + TRC) with a digital self-management-only (DP) program in patients with uncontrolled asthma. The DP included electronic medication sensors that captured the date and time of both short-acting beta agonist (SABA) and controller medication usage. The TRC included remote care oversight to promote inhaler adherence and address symptom worsening. SABA usage, controller adherence and program retention were assessed retrospectively using regression models controlling for age, enrollment year, controller/SABA use, and baseline asthma control status.18,584 DP patients (mean age (SD): 33 (14.6) yrs; 89.9% uncontrolled asthma) and 3440 DP + TRC patients (mean age (SD): 43.7 (15.6) yrs); 48.6% uncontrolled) were assessed. We observed significantly better six-month program retention (55% vs. 41%, p < 0.001) and controller adherence (54% vs. 45%, p < 0.001), but no statistically significant differences in mean SABA use (0.76 vs. 0.87 mean puffs/day; p = 0.158) for the DP + TRC vs. DP groups, respectively. From baseline to six months, both groups had similar reductions in mean daily SABA use (both p < 0.001) and improvements in the percent of SABA-free days (both p < 0.001). The proportion of patients with ≥80% controller adherence declined in both groups, but a larger relative decline was noted in the DP vs. DP + TRC group. A digital self-management platform for asthma management combined with virtual clinical oversight may offer a scalable solution that not only achieves reduced SABA use, but also promotes medication adherence and increases program retention.