Clinical and cost effectiveness of mobile phone supported self monitoring of asthma

multicentre randomised controlled trial

Dermot Ryan*, David Price, Stan D. Musgrave, Shweta Malhotra, Amanda J. Lee, Dolapo Ayansina, Aziz Sheikh, Lionel Tarassenko, Claudia Pagliari, Hilary Pinnock

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

Objective To determine whether mobile phone based monitoring improves asthma control compared with standard paper based monitoring strategies.

Design Multicentre randomised controlled trial with cost effectiveness analysis.

Setting UK primary care.

Participants 288 adolescents and adults with poorly controlled asthma (asthma control questionnaire (ACQ) score >= 1.5) from 32 practices.

Intervention Participants were centrally randomised to twice daily recording and mobile phone based transmission of symptoms, drug use, and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring.

Main outcome measures Changes in scores on asthma control questionnaire and self efficacy (knowledge, attitude, and self efficacy asthma questionnaire (KASE-AQ)) at six months after randomisation. Assessment of outcomes was blinded. Analysis was on an intention to treat basis.

Results There was no significant difference in the change in asthma control or self efficacy between the two groups (ACQ: mean change 0.75 in mobile group v 0.73 in paper group, mean difference in change -0.02 (95% confidence interval -0.23 to 0.19); KASE-AQ score: mean change -4.4 v -2.4, mean difference 2.0 (-0.3 to 4.2)). The numbers of patients who had acute exacerbations, steroid courses, and unscheduled consultations were similar in both groups, with similar healthcare costs. Overall, the mobile phone service was more expensive because of the expenses of telemonitoring.

Conclusions Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines standards. The mobile technology was not cost effective.

Original languageEnglish
Article numbere1756
Number of pages15
JournalBMJ (Clinical research ed.)
Volume344
DOIs
Publication statusPublished - 23 Mar 2012

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Cell Phones
Ego
Cost-Benefit Analysis
Asthma
Randomized Controlled Trials
Self Efficacy
Outcome Assessment (Health Care)
Technology
Random Allocation
Health Care Costs
Primary Health Care
Referral and Consultation
Steroids
Surveys and Questionnaires
Guidelines
Confidence Intervals
Costs and Cost Analysis
Control Groups

Keywords

  • Adolescent
  • Adult
  • Asthma
  • Attitude to Health
  • Cellular Phone
  • Cost-Benefit Analysis
  • Directive Counseling
  • Female
  • Hotlines
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic
  • Outcome Assessment (Health Care)
  • Patient Participation
  • Primary Health Care
  • Quality of Life
  • Questionnaires
  • Remote Consultation
  • Self Care
  • Treatment Outcome
  • Technology
  • Management
  • Validation
  • Quality-of-life questionnaire
  • System
  • Childhood asthma
  • Long-term
  • Primary-care

Cite this

Clinical and cost effectiveness of mobile phone supported self monitoring of asthma : multicentre randomised controlled trial. / Ryan, Dermot; Price, David; Musgrave, Stan D.; Malhotra, Shweta; Lee, Amanda J.; Ayansina, Dolapo; Sheikh, Aziz; Tarassenko, Lionel; Pagliari, Claudia; Pinnock, Hilary.

In: BMJ (Clinical research ed.), Vol. 344, e1756, 23.03.2012.

Research output: Contribution to journalArticle

Ryan, Dermot ; Price, David ; Musgrave, Stan D. ; Malhotra, Shweta ; Lee, Amanda J. ; Ayansina, Dolapo ; Sheikh, Aziz ; Tarassenko, Lionel ; Pagliari, Claudia ; Pinnock, Hilary. / Clinical and cost effectiveness of mobile phone supported self monitoring of asthma : multicentre randomised controlled trial. In: BMJ (Clinical research ed.). 2012 ; Vol. 344.
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abstract = "Objective To determine whether mobile phone based monitoring improves asthma control compared with standard paper based monitoring strategies.Design Multicentre randomised controlled trial with cost effectiveness analysis.Setting UK primary care.Participants 288 adolescents and adults with poorly controlled asthma (asthma control questionnaire (ACQ) score >= 1.5) from 32 practices.Intervention Participants were centrally randomised to twice daily recording and mobile phone based transmission of symptoms, drug use, and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring.Main outcome measures Changes in scores on asthma control questionnaire and self efficacy (knowledge, attitude, and self efficacy asthma questionnaire (KASE-AQ)) at six months after randomisation. Assessment of outcomes was blinded. Analysis was on an intention to treat basis.Results There was no significant difference in the change in asthma control or self efficacy between the two groups (ACQ: mean change 0.75 in mobile group v 0.73 in paper group, mean difference in change -0.02 (95{\%} confidence interval -0.23 to 0.19); KASE-AQ score: mean change -4.4 v -2.4, mean difference 2.0 (-0.3 to 4.2)). The numbers of patients who had acute exacerbations, steroid courses, and unscheduled consultations were similar in both groups, with similar healthcare costs. Overall, the mobile phone service was more expensive because of the expenses of telemonitoring.Conclusions Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines standards. The mobile technology was not cost effective.",
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author = "Dermot Ryan and David Price and Musgrave, {Stan D.} and Shweta Malhotra and Lee, {Amanda J.} and Dolapo Ayansina and Aziz Sheikh and Lionel Tarassenko and Claudia Pagliari and Hilary Pinnock",
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AU - Ryan, Dermot

AU - Price, David

AU - Musgrave, Stan D.

AU - Malhotra, Shweta

AU - Lee, Amanda J.

AU - Ayansina, Dolapo

AU - Sheikh, Aziz

AU - Tarassenko, Lionel

AU - Pagliari, Claudia

AU - Pinnock, Hilary

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N2 - Objective To determine whether mobile phone based monitoring improves asthma control compared with standard paper based monitoring strategies.Design Multicentre randomised controlled trial with cost effectiveness analysis.Setting UK primary care.Participants 288 adolescents and adults with poorly controlled asthma (asthma control questionnaire (ACQ) score >= 1.5) from 32 practices.Intervention Participants were centrally randomised to twice daily recording and mobile phone based transmission of symptoms, drug use, and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring.Main outcome measures Changes in scores on asthma control questionnaire and self efficacy (knowledge, attitude, and self efficacy asthma questionnaire (KASE-AQ)) at six months after randomisation. Assessment of outcomes was blinded. Analysis was on an intention to treat basis.Results There was no significant difference in the change in asthma control or self efficacy between the two groups (ACQ: mean change 0.75 in mobile group v 0.73 in paper group, mean difference in change -0.02 (95% confidence interval -0.23 to 0.19); KASE-AQ score: mean change -4.4 v -2.4, mean difference 2.0 (-0.3 to 4.2)). The numbers of patients who had acute exacerbations, steroid courses, and unscheduled consultations were similar in both groups, with similar healthcare costs. Overall, the mobile phone service was more expensive because of the expenses of telemonitoring.Conclusions Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines standards. The mobile technology was not cost effective.

AB - Objective To determine whether mobile phone based monitoring improves asthma control compared with standard paper based monitoring strategies.Design Multicentre randomised controlled trial with cost effectiveness analysis.Setting UK primary care.Participants 288 adolescents and adults with poorly controlled asthma (asthma control questionnaire (ACQ) score >= 1.5) from 32 practices.Intervention Participants were centrally randomised to twice daily recording and mobile phone based transmission of symptoms, drug use, and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring.Main outcome measures Changes in scores on asthma control questionnaire and self efficacy (knowledge, attitude, and self efficacy asthma questionnaire (KASE-AQ)) at six months after randomisation. Assessment of outcomes was blinded. Analysis was on an intention to treat basis.Results There was no significant difference in the change in asthma control or self efficacy between the two groups (ACQ: mean change 0.75 in mobile group v 0.73 in paper group, mean difference in change -0.02 (95% confidence interval -0.23 to 0.19); KASE-AQ score: mean change -4.4 v -2.4, mean difference 2.0 (-0.3 to 4.2)). The numbers of patients who had acute exacerbations, steroid courses, and unscheduled consultations were similar in both groups, with similar healthcare costs. Overall, the mobile phone service was more expensive because of the expenses of telemonitoring.Conclusions Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines standards. The mobile technology was not cost effective.

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