1. 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

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

3. 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.

4. 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

5. Self-monitoring

6. eHealth self-management support

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

8. 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

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

10. 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

11. 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

12. Successful eHealth?

13. eHealth implementation

14. 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.

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

16. Successful eHealth / Hype cycle
Challenge

17. 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

18. 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

19. 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

20. 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

21. 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

22. Thank you