Asthma Controller Adherence After Hospitalization
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      This study sets out to assess whether daily text message reminders help to enhance the
      consistency of use of controller medications following hospitalization for pediatric asthma
      patients ages 4-11 and their families. Text message reminders will be delivered to a
      subject's cell phone for those in the intervention group and electronic monitors will placed
      on the controller inhalers at the time of hospital discharge to track medication use over
      time in both the intervention and the regular care group. Families will complete surveys on
      the day of enrollment (in person), day 30 (telephone) and day 60 (telephone) on aspects of
      asthma care including asthma knowledge, medication routines, who is responsible for asthma
      care, and medication beliefs.
    

Detailed description: 
      Poor adherence to inhaled controller medications for asthma is a well-documented and poorly
      understood problem with a disproportionate prevalence and impact on urban minority children.
      Recent randomized trials from other countries using electronic monitoring of inhaled steroids
      with automated adherence feedback demonstrated dramatic improvements in adherence behavior.
      Whether similar intervention effects can be expected in high-risk children in the US is
      unknown.

      To accomplish the above objectives, investigators propose to enroll 40 children and their
      parents (20 parent/child dyads in each arm) in a two-month pilot randomized controlled trial
      of an automated adherence feedback intervention. Children will be from West Philadelphia,
      ages 4-11, and must be hospitalized for asthma at The Children's Hospital of Philadelphia
      (CHOP).

      The study intervention will include daily automated medication reminders via text messaging
      for those subjects randomized to the intervention group. Inhaled controller medication
      adherence will be measured in both groups using electronic monitors affixed to the top of the
      canister of the inhaled steroid medication and adherence trajectories will be determined
      using group-based trajectory modeling. Factors associated with adherence trajectories will be
      assessed using a survey completed upon enrollment, completion of the treatment phase (1
      month) and upon completion of follow up (2 months). Feasibility outcomes will include use,
      acceptance, and preferences. Limited efficacy outcomes will include change in parent-reported
      asthma control and difference in average percent adherence between intervention and control
      conditions.

      Findings from this study will provide preliminary data for a larger study evaluating the
      mechanisms of differential adherence trajectories and the effect of an adherence feedback
      intervention for different mechanisms of non-adherence.
    

Intervention name(s): Daily Text message reminder; Inhaled steroid canister monitor
Intervention type(s): Behavioral; Device
Intervention description(s): Subjects in the intervention arm will receive once daily text messages at the time of their choice or at a default time of 7am. The text message will remind them to give their child their controller medication and provide a helpful information on asthma controller use.; An electronic monitor will be affixed to subjects' inhaled steroid canister and families will be instructed to use the inhaler as directed by their physician. Subjects will not receive daily text messages.The canister monitor, the Propeller sensor (Propeller, Madison, Wisconsin) is an FDA-approved, portable device which affixes to the top of most metered dose inhaler canisters. The devices records the number and time of each inhaler actuation and transmits this information to either a smart phone or cellular modem. Data is then sent via the cellular network to the secure Propeller server. The data will then be downloaded monthly.
Other intervention name(s): Propeller Health Bluetooth Low Energy (BLE) Sensor
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research