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Internet asthma education

Trial
Results
Comment

Patient education is seen as being a critical component of quality asthma care, but education is difficult to provide. Typically it has demanded one-on-one effort from professionals, and there simply are not enough, nor are they well enough supported or resourced. Given that major effort should be put into young asthma patients, and that young asthma patients are often highly computer literate, using the Internet would seem to be the obvious way to solve myriad problems at one fell swoop. A randomised trial shows how well it can work[1].

Trial

The population was children at a clinic in Missouri, under 18 years with a diagnosis of asthma. All children meeting eligibility were invited to participate, and there were no exclusions because of asthma severity.

Randomisation was to control group or Internet participation group. The control group received asthma education as part of usual care, including verbal and printed information, with 26 instruction sheets available. Education was provided by a nurse practitioner with a total time of 1.5 hours over three initial visits, plus more time if needed or at times of management change.

The Internet group in addition had access to a multimedia programme for asthma control and tracking, incorporating vignettes, principles of self-management, and animated lessons. This programme was accessed through the Internet, but only made available during clinic visits, principally to avoid bias in group comparisons. Participants used the programme at every visit.

Data were collected at an initial visit, and then at three and 12 months. This included instruments to measure knowledge about asthma for caregivers, and children aged 7-17 years.

Results

Initially 246 children were randomised, with 228 participating fully. Just under half the children were aged six or below. The two groups were well matched.

Knowledge scores were higher for caregivers and children aged 7-17 years at three and 12 months in both groups, but children in the Internet group had higher scores than those in the usual care group.

Children in the Internet and control group had fewer days with asthma symptoms between the first and last visit. With usual care the mean and median reductions were 44 and 17 days, but in the Internet group mean and median reductions were 88 and 58 days. The Internet group had a significantly greater reduction in days with asthma symptoms per year (Figure 1), and this reduction in days with asthma symptoms was achieved with a significantly lower dose of inhaled corticosteroids (by an average of 300 μg/day beclomethasone equivalents, Figure 2).



Figure 1: Asthma symptoms with Internet users and usual care control







Figure 2: Inhaled corticosteroid dose in Internet users and usual care controls





Comment

This is another interesting study showing how the Internet could help to deliver better care. In this case access was limited because of a need to avoid contaminating the comparison group. Had the programme been open to children at home to access at any time, the impact might have been greater.

Young asthma patients with more knowledge of their condition, with fewer days of symptoms, and with much less use of inhaled corticosteroid, is something of a holy grail in asthma management. The fact that it can be delivered in a way that is certain to be at relatively low cost using the Internet is a wake-up call to those who want to use IT intelligently. Perhaps a rather more important use of computers than just for storing patient records.

Reference:

  1. S Krishna et al. Internet-enabled interactive multimedia asthma educational program: a randomized trial. Pediatrics 2003 111: 503-510.

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