1. 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

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

3. 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

4. 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

5. 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)

6. 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?

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

8. 6 clusters could be detected
Based on smoking, spirometry, ACQ, CCQ, age of onset and hyper reactivity

9. 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

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

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

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

13. 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!

14. 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

15. 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

16. 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

17. Thank you for your attention