Successful eHealth interventions Successful eHealth interventions in asthma Dr Jacob K. Sont, associate professor LUMC-Quality of Care-Institute / Dept. of Medical Decision Making Leiden University Medical Center LEIDEN The Netherlands E-mail: j.k.sont@lumc.nl

Disclosures J.K. Sont Research Support EU Horizon2020, Lung Foundation, ZonMW, GSK, Chiesi, Boehringer Ingelheim, NutsOhra Employee Leiden University Medical Center

eHealth / mHealth interventions Treatments that are operationalized and transformed for delivery via the Internet behaviorally based includes mobile health (mHealth) interventions delivered through mobile devices or the new generation of tablet computers Eysenbach G. CONSORT-EHEALTH. Medinfo, 2013.

Asthma self-management Accept the diagnosis and understand the condition Understand the purpose of the medications and be able to use medication and devices correctly Appreciate the importance of environmental influences, including lifestyle Recognise factors that make the condition worse Understand the value of self-monitoring Be able to recognise and treat worsening symptoms or function Know when to seek urgent medical attention Appreciate the need for regular structured review Reddel et al. Int J Tuberc Lung Dis 2014

Self-monitoring

eHealth self-management support

SMASHING study adults (18-50 yr) Van der Meer et al. Ann Intern Med 2009 Van Gaalen et al. JMIR 2013

Asthma related quality of life 6.5 6 p=0.03 AQLQ-score 5.5 Internet-based self-management Usual care 5 6 12 18 24 30 Month follow-up Van der Meer et al. Ann Intern Med 2009 Van Gaalen et al. JMIR 2013

Digital Asthma Self-Management Interventions Metareview 10 reviews 19 unique RCT 2315 patients Morrison D et al. J Med Internet Res 2014

Digital Asthma Self-Management Interventions Outcome # RCTs # RCTs with stat. sign. effect Favours control No diff. Favours intervention Activity limitation 2 oo Knowledge Markers of self-care 7 o oooooo Quality of life ooo oooo Medication use 3 Symptoms 12 Missing school 4 Lung function ED visits 6 Hospitalization 5 ooooo Prim. care visits Morrison D et al. J Med Internet Res 2014

Digital Asthma Self-Management Interventions Metareview Digital Asthma Self-Management Interventions: show promise, with evidence of beneficial effects on some outcomes no evidence about utility in those over 65 years and no information about socioeconomic status of participants, making understanding the “reach” of such interventions difficult digital interventions are poorly described within reviews, with insufficient information about barriers and facilitators to their uptake and utilization Morrison D et al. J Med Internet Res 2014

Successful eHealth?

eHealth implementation

eHealth / mHealth interventions Treatments that are operationalized and transformed for delivery via the Internet behaviorally based includes mobile health (mHealth) interventions delivered through mobile devices or the new generation of tablet computers mobile computing, medical sensors, and communications technologies that can enhance chronic disease Eysenbach G. CONSORT-EHEALTH. Medinfo, 2013. mHealth—Mobile Health Technologies. NIH, 2014.

Mobile health applications for asthma Apps N = 209 April 2014 Quality? Privacy risks? Effectiveness? Wu AC et al. J Allergy Clin Immunol Pract 2015

Successful eHealth / Hype cycle Challenge

User centred design Determine the opinions of individuals with asthma and of healthcare professionals on the use and functionality of mHealth systems to support asthma self-management Specifically, we aimed to: determine end-user experiences and perceived uses of mHealth systems for asthma self-management determine end-user opinions of what measurements and alerts would be useful in managing asthma identify barriers and considerations of using mHealth systems

Focus groups patients “I really dislike going to my asthma check up when I am pretty sure it is fairly well controlled anyway…. I go and they tell me what I already know… it would be nice if a device could feedback to the nurse and they could let me know when I should get a check-up”. [Patient #2, London]; “I don’t want to measure all those things… if it is one or maybe two things I might, or if you could personalise it to what is relevant to you, but I’m not going to measure all of those things” [Patient #3, Leiden]. Horizon 2020 European Union Funding for Research & Innovation Simpson A et al. submitted

Focus group health care provider “not all of the asthmatic patients have the same symptoms… I think you need to individualise the symptoms and what is measured to every patient separately” [HCP #5]. “A little bit of a prompt to say that at these levels maybe you should be seeking medical attention, this would be helpful because then they may attend accident & emergency department a little bit sooner”. [HCP #2] Horizon 2020 European Union Funding for Research & Innovation Simpson A et al. submitted

myAirCoach mHealth building blocks Personalized Modeling Horizon 2020 European Union Funding for Research & Innovation Smart Inhaler Digital Patient Record Virtual Community Platform Prediction Capabilities Patient Doctor Communication Decision Support Tools Novel Visualization Approaches

Successful eHealth interventions User-centred design Problem-driven / theory-based / barriers for SM Role of health care provider Evidence effectiveness not sufficient increasing, sustained effect on asthma control and quality of life Privacy risks Business case mHealth technologies improve “population reach“ settings where infrastructure is restricted Personalised self-management support Novel sensor-based mHealth technologies have further potential

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