Development of a blueprint for an individualized self-management eHealth tool for asthma patients in primary care Esther Metting, Folkert van Bruggen, Janwillem Kocks, Thys van der Molen

Two major achievements Digitalized! Information available online Technology Physician as coach Patients more involved in treatment However, current self management poor (in general)

According to literature What is known? Effective tools According to literature Mobile phone messaging may provide self-management benefit Internet based contact with clinic increased satisfaction DREAM project in RA patients reduced inflammation Patient web portal for cancer patients enhanced satisfaction Tele healthcare interventions for asthma can reduce hospital admissions in severe asthma Mobile asthma Action Plan improved satisfaction and asthma control Mobile phone monitoring system Improved lung function, QoL, healthcare use However, variation in population/intervention/outcomes/patients Background

Aim of this study To develop a blueprint for an individualized self-management eHealth tool for asthma patients in primary care Presentation of the scaffolding process

Etcetera…. How does an asthma patient look like?? Allergic asthma patient Smoking asthma patient Etcetera…. Exercise-induced asthma Lindsay Lohan, actress, singer, model (1986) Frank Lampard, football player (1978) Bono, singer (1960)

And what about patients’ preferences and attitudes? Relation between attitudes and self-management style REALISE study , D.Price et al: “I ignore my asthma and its symptoms so I can feel normal and fit in with my friends/peers” 82% (partially) uncontrolled  How to improve self-management in these patients?

Phenotyping by cluster analysis Patients in the Asthma/COPD service (regardless of diagnosis) Dr. JWH Kocks

6 clusters could be detected Based on smoking, spirometry, ACQ, CCQ, age of onset and hyper reactivity

Methods 1) Identification success-factors in current eHealth tools (literature study) 2) Development of individual patient profiles and medical management advices based on retrospective patient data (14.000) 3) Development of individual patient targeted disease related self-management advices

Development of patient profiles Asthma/COPD service Groningen (>14,000 patients) Cooperation between GPs and pulmonologists

Development of the advices Current guidelines for GP in the Netherlands Combined that information with advices from the pulmonologists (database) Individualized information

Results (1): Literature study Success factors Feedback to (self-management) data The use of electronic devices Asthma education

Results (2): patient profiles We extracted data from 5000 asthma patients from the database Patient characteristics (age/gender/smoking/work status) Disease status (diagnosis/severity/triggers) Current treatment (medication)  Many combinations!

Examples of patient profiles Example, patient 1: Male, age 40, Smoking Allergic to dust, prescribed with combination therapy Cluster A (poor prognosis), poor controlled Attitude: not concerned about asthma. Example, patient 2: Male, age 30, non smoking Exercise induced, prescribed with ICS and SABA Cluster D (good prognosis), poor controlled Attitude: concerned about asthma

Examples of patient profiles Examples of advices Example, patient 1: Male, age 40, Smoking Allergic to dust, prescribed with combination therapy Cluster A (poor prognosis), poor controlled Attitude: not concerned about asthma. Advice Referral quit smoking advice How to avoid dust, how to cope with dust allergy Intensive monitoring and quick referral advice Education about asthma and consequences poor asthma control Example, patient 2: Male, age 30, non smoking Exercise induced, prescribed with ICS and SABA Cluster D (good prognosis), poor controlled Attitude: concerned about asthma Advice Very good! Information about smoking and asthma How to prevent complaints during exercise Monitor asthma control and show improvement to patient Education

Future steps/Discussion The development of the tool In the Asthma/COPD-service RCT to study its impact on asthma control? Potential users, to whom available? Adults, severity of disease Extension to other diseases Cost effectiveness Efficient Enkele vervolgstappen en discussiepunten. Enkele discussiepunten want anders overdaad ben ik bang

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