The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial

Sara Ahmed, Pierre Ernst, Susan J Bartlett, Marie-France Valois, Tasneem Zaihra, Guy Paré, Roland Grad, Owis Eilayyan, Robert Perreault, Robyn Tamblyn, Sara Ahmed, Pierre Ernst, Susan J Bartlett, Marie-France Valois, Tasneem Zaihra, Guy Paré, Roland Grad, Owis Eilayyan, Robert Perreault, Robyn Tamblyn

Abstract

Background: Whether Web-based technologies can improve disease self-management is uncertain. My Asthma Portal (MAP) is a Web-based self-management support system that couples evidence-based behavioral change components (self-monitoring of symptoms, physical activity, and medication adherence) with real-time monitoring, feedback, and support from a nurse case manager.

Objective: The aim of this study was to compare the impact of access to a Web-based asthma self-management patient portal linked to a case-management system (MAP) over 6 months compared with usual care on asthma control and quality of life.

Methods: A multicenter, parallel, 2-arm, pilot, randomized controlled trial was conducted with 100 adults with confirmed diagnosis of asthma from 2 specialty clinics. Asthma control was measured using an algorithm based on overuse of fast-acting bronchodilators and emergency department visits, and asthma-related quality of life was assessed using the Mini-Asthma Quality of Life Questionnaire (MAQLQ). Secondary mediating outcomes included asthma symptoms, depressive symptoms, self-efficacy, and beliefs about medication. Process evaluations were also included.

Results: A total of 49 individuals were randomized to MAP and 51 to usual care. Compared with usual care, participants in the intervention group reported significantly higher asthma quality of life (mean change 0.61, 95% CI 0.03 to 1.19), and the change in asthma quality of life for the intervention group between baseline and 3 months (mean change 0.66, 95% CI 0.35 to 0.98) was not seen in the control group. No significant differences in asthma quality of life were found between the intervention and control groups at 6 (mean change 0.46, 95% CI -0.12 to 1.05) and 9 months (mean change 0.39, 95% CI -0.2 to 0.98). For poor control status, there was no significant effect of group, time, or group by time. For all self-reported measures, the intervention group had a significantly higher proportion of individuals, demonstrating a minimal clinically meaningful improvement compared with the usual care group.

Conclusions: This study supported the use of MAP to enhance asthma quality of life but not asthma control as measured by an administrative database. Implementation of MAP beyond 6 months with tailored protocols for monitoring symptoms and health behaviors as individuals' knowledge and self-management skills improve may result in long-term gains in asthma control.

Clinicaltrial: International Standard Randomized Controlled Trial Number (ISRCTN): 34326236; http://www.isrctn.com/ISRCTN34326236 (Archived by Webcite at http://www.webcitation.org/6mGxoI1R7).

Keywords: Internet; asthma; case management; nursing; quality of life; self-care.

Conflict of interest statement

Conflicts of Interest: None declared.

©Sara Ahmed, Pierre Ernst, Susan J Bartlett, Marie-France Valois, Tasneem Zaihra, Guy Paré, Roland Grad, Owis Eilayyan, Robert Perreault, Robyn Tamblyn. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.12.2016.

Figures

Figure 1
Figure 1
Consort diagram of participants in the My Asthma Portal (MAP) trial.
Figure 2
Figure 2
Average number of logins by week over the 6-month study period.
Figure 3
Figure 3
Usage of My Asthma Portal (MAP) features over time.
Figure 4
Figure 4
Minimal clinically important difference at 6 months on the patient reported outcomes. MAQLQ: Mini-Asthma Quality of Life Questionnaire; ACT: Asthma Control Test; EQ-VAS: EuroQol visual analogue scale; PHQ: Patient Health Questionnaire.

References

    1. Boulet LP, Bai TR, Becker A, Bérubé D, Beveridge R, Bowie DM, Chapman KR, Côté J, Cockcroft D, Ducharme FM, Ernst P, FitzGerald JM, Kovesi T, Hodder RV, O'Byrne P, Rowe B, Sears MR, Simons FE, Spier S. What is new since the last (1999) Canadian Asthma Consensus Guidelines? Can Respir J. 2001;8(Suppl A):5A–27A.
    1. Ernst E. Complementary therapies for asthma: what patients use. J Asthma. 1998;35(8):667–71.
    1. Turner MO, Taylor D, Bennett R, Fitzgerald JM. A randomized trial comparing peak expiratory flow and symptom self-management plans for patients with asthma attending a primary care clinic. Am J Respir Crit Care Med. 1998 Feb;157(2):540–6. doi: 10.1164/ajrccm.157.2.9703060.
    1. Tattersfield AE, Postma DS, Barnes PJ, Svensson K, Bauer CA, O'Byrne PM, Löfdahl CG, Pauwels RA, Ullman A. Exacerbations of asthma: a descriptive study of 425 severe exacerbations. The FACET International Study Group. Am J Respir Crit Care Med. 1999 Aug;160(2):594–9. doi: 10.1164/ajrccm.160.2.9811100.
    1. Bonner S, Zimmerman BJ, Evans D, Irigoyen M, Resnick D, Mellins RB. An individualized intervention to improve asthma management among urban Latino and African-American families. J Asthma. 2002 Apr;39(2):167–79.
    1. Gibson PG. Monitoring the patient with asthma: an evidence-based approach. J Allergy Clin Immunol. 2000 Jul;106(1 Pt 1):17–26. doi: 10.1067/mai.2000.108307.
    1. Hartert TV, Windom HH, Peebles RS, Freidhoff LR, Togias A. Inadequate outpatient medical therapy for patients with asthma admitted to two urban hospitals. Am J Med. 1996 Apr;100(4):386–94.
    1. Crain EF, Kercsmar C, Weiss KB, Mitchell H, Lynn H. Reported difficulties in access to quality care for children with asthma in the inner city. Arch Pediatr Adolesc Med. 1998 Apr;152(4):333–9.
    1. Dinkevich EI, Cunningham SJ, Crain EF. Parental perceptions of access to care and quality of care for inner-city children with asthma. J Asthma. 1998;35(1):63–71.
    1. FitzGerald JM, Boulet L, McIvor RA, Zimmerman S, Chapman KR. Asthma control in Canada remains suboptimal: the Reality of Asthma Control (TRAC) study. Can Respir J. 2006;13(5):253–9.
    1. Eccles MP, Armstrong D, Baker R, Cleary K, Davies H, Davies S, Glasziou P, Ilott I, Kinmonth AL, Leng G, Logan S, Marteau T, Michie S, Rogers H, Rycroft-Malone J, Sibbald B. An implementation research agenda. Implement Sci. 2009 Apr 07;4:18. doi: 10.1186/1748-5908-4-18.
    1. Morrison D, Wyke S, Agur K, Cameron EJ, Docking RI, Mackenzie AM, McConnachie A, Raghuvir V, Thomson NC, Mair FS. Digital asthma self-management interventions: a systematic review. J Med Internet Res. 2014;16(2):e51. doi: 10.2196/jmir.2814.
    1. van der Meer V, Bakker MJ, van den Hout WB, Rabe KF, Sterk PJ, Kievit J, Assendelft WJ, Sont JK, SMASHING (Self-Management in Asthma Supported by Hospitals‚ ICT‚ NursesGeneral Practitioners) Study Group Internet-based self-management plus education compared with usual care in asthma: a randomized trial. Ann Intern Med. 2009 Jul 21;151(2):110–20.
    1. Rasmussen LM, Phanareth K, Nolte H, Backer V. Internet-based monitoring of asthma: a long-term, randomized clinical study of 300 asthmatic subjects. J Allergy Clin Immunol. 2005 Jun;115(6):1137–42. doi: 10.1016/j.jaci.2005.03.030.
    1. Ahmed S, Bartlett SJ, Ernst P, Paré G, Kanter M, Perreault R, Grad R, Taylor L, Tamblyn R. Effect of a web-based chronic disease management system on asthma control and health-related quality of life: study protocol for a randomized controlled trial. Trials. 2011;12:260. doi: 10.1186/1745-6215-12-260.
    1. Kelders SM, Kok RN, Ossebaard HC, Van Gemert-Pijnen JE. Persuasive system design does matter: a systematic review of adherence to web-based interventions. J Med Internet Res. 2012 Nov 14;14(6):e152. doi: 10.2196/jmir.2104.
    1. Juniper EF, Price DB, Stampone PA, Creemers JP, Mol SJ, Fireman P. Clinically important improvements in asthma-specific quality of life, but no difference in conventional clinical indexes in patients changed from conventional beclomethasone dipropionate to approximately half the dose of extrafine beclomethasone dipropionate. Chest. 2002 Jun;121(6):1824–32.
    1. Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly. 1989 Sep;13(3):319–40. doi: 10.2307/249008.
    1. Hendrickson AR, Massey PD, Cronan TP. On the test-retest reliability of perceived usefulness and perceived ease of use scales. MIS Quarterly. 1993 Jun;17(2):227–30. doi: 10.2307/249803.
    1. Adams DA, Nelson RR, Todd PA. Perceived usefulness, ease of use, and usage of information technology: a replication. MIS Quarterly. 1992 Jun;16(2):227–47. doi: 10.2307/249577.
    1. Szajna B. Empirical evaluation of the revised technology acceptance model. Management Science. 1996 Jan. 1996;42(1):85. doi: 10.1287/mnsc.42.1.85.
    1. Spitzer WO, Suissa S, Ernst P, Horwitz RI, Habbick B, Cockcroft D, Boivin JF, McNutt M, Buist AS, Rebuck AS. The use of beta-agonists and the risk of death and near death from asthma. N Engl J Med. 1992 Feb 20;326(8):501–6. doi: 10.1056/NEJM199202203260801.
    1. Juniper EF, Guyatt GH, Cox FM, Ferrie PJ, King DR. Development and validation of the Mini Asthma Quality of Life Questionnaire. Eur Respir J. 1999 Jul;14(1):32–8.
    1. Ehrs PO, Nokela M, Ställberg B, Hjemdahl P, Wikström JE. Brief questionnaires for patient-reported outcomes in asthma: validation and usefulness in a primary care setting. Chest. 2006 Apr;129(4):925–32. doi: 10.1378/chest.129.4.925.
    1. Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum. 1989 Jan;32(1):37–44.
    1. Tobin DL, Wigal JK, Winder JA, Holroyd KA, Creer TL. The “asthma self-efficacy scale”. Ann Allergy. 1987 Oct;59(4):273–7.
    1. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, Murray JJ, Pendergraft TB. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004 Jan;113(1):59–65. doi: 10.1016/j.jaci.2003.09.008.
    1. Schatz M, Sorkness CA, Li JT, Marcus P, Murray JJ, Nathan RA, Kosinski M, Pendergraft TB, Jhingran P. Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J Allergy Clin Immunol. 2006 Mar;117(3):549–56. doi: 10.1016/j.jaci.2006.01.011.
    1. Juniper EF. Using humanistic health outcomes data in asthma. Pharmacoeconomics. 2001;19(Suppl 2):13–9.
    1. Emilsson M, Berndtsson I, Lötvall J, Millqvist E, Lundgren J, Johansson A, Brink E. The influence of personality traits and beliefs about medicines on adherence to asthma treatment. Prim Care Respir J. 2011 Jun;20(2):141–7. doi: 10.4104/pcrj.2011.00005.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606–13.
    1. Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ. 2012 Feb 21;184(3):E191–6. doi: 10.1503/cmaj.110829.
    1. Brooks R. EuroQol: the current state of play. Health Policy. 1996 Jul;37(1):53–72. doi: 10.1016/0168-8510(96)00822-6.
    1. Wilchesky M, Tamblyn RM, Huang A. Validation of diagnostic codes within medical services claims. J Clin Epidemiol. 2004 Feb;57(2):131–41. doi: 10.1016/S0895-4356(03)00246-4.
    1. Regie de l'assurance-maladie du Quebec Statistiques Annuelles. Regie de l'assurance-maladie du Quebec. 2000:46–48.
    1. Jiang J. Linear and generalized linear mixed models and their applications. New York: Springer; 2007.
    1. Schafer JL. Analysis of incomplete multivariate data. Boca Raton, Florida: CRC press; 1997.
    1. Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the patient health questionnaire-9. Med Care. 2004 Dec;42(12):1194–201.
    1. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003 May;41(5):582–92. doi: 10.1097/01.MLR.0000062554.74615.4C.
    1. McDermott MS, While AE. Maximizing the healthcare environment: a systematic review exploring the potential of computer technology to promote self-management of chronic illness in healthcare settings. Patient Educ Couns. 2013 Jul;92(1):13–22. doi: 10.1016/j.pec.2013.02.014.
    1. Fayers P, Machin D. Quality of life: the assessment, analysis and interpretation of patient-reported outcomes. England: John Wiley & Sons; 2013.
    1. Vassilev I, Rowsell A, Pope C, Kennedy A, O'Cathain A, Salisbury C, Rogers A. Assessing the implementability of telehealth interventions for self-management support: a realist review. Implement Sci. 2015;10:59. doi: 10.1186/s13012-015-0238-9.
    1. Al-Durra M, Torio MB, Cafazzo JA. The use of behavior change theory in Internet-based asthma self-management interventions: a systematic review. J Med Internet Res. 2015 Apr 02;17(4):e89. doi: 10.2196/jmir.4110.
    1. Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns. 2002;48(2):177–87.
    1. Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003 Aug;26(1):1–7.
    1. Bacon SL, Lemiere C, Moullec G, Ninot G, Pepin V, Lavoie KL. Association between patterns of leisure time physical activity and asthma control in adult patients. BMJ Open Resp Res. 2015 Jul 24;2(1):e000083. doi: 10.1136/bmjresp-2015-000083.
    1. Pal K, Eastwood SV, Michie S, Farmer AJ, Barnard ML, Peacock R, Wood B, Inniss JD, Murray E. Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2013;3:CD008776. doi: 10.1002/14651858.CD008776.pub2.
    1. Wieland LS, Falzon L, Sciamanna CN, Trudeau KJ, Brodney S, Schwartz JE, Davidson KW. Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people. Cochrane Database Syst Rev. 2012;8:CD007675. doi: 10.1002/14651858.CD007675.pub2.

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