Automated telephone reminders improve asthma medication compliance

Combining speech-recognition software with electronic health records in computerized telephone conversations to remind parents of asthmatic children about prescribed corticosteroids significantly improves adherence to medication, a recent study showed.

Investigators divided 1187 families in Kaiser Permanente Colorado with children, aged from 3 to 12 years with persistent asthma and a prescription for an inhaled corticosteroid, into 2 groups. One group received the telephone call intervention and the other usual care.

Families in the intervention group received 3 types of calls, all of which were based on speech-recognition technology: an initial welcome call followed by basic refill calls and tardy refill calls that were triggered when an inhaled corticosteroid refill was due or overdue. The initial welcome call was placed the first time the child’s prescription was overdue by 14 days and provided multiple options for refilling the child’s medication or speaking with an asthma care nurse or pharmacist. The basic refill call was placed 10 days before the child was to run out of medication and included a reminder of the need to refill the prescription, help doing so, and the option of getting assistance through a callback from a pharmacy staff member or asthma care nurse. Parents of a child who was more than 30 days past due for medication received a tardy refill call, which was similar to the basic refill call although it placed more emphasis on the importance of medication adherence. All calls were placed until a parent or answering machine was reached.

The usual care group could request allergist care at any time without referral from a primary care physician. Throughout the study, all standard asthma resources, including visits with pediatricians, family physicians, and allergists, were available to both the intervention and usual care groups.

During the first year of the 2-year study period, corticosteroid adherence was 25.4% higher in the intervention group than in the usual care group (44.5% vs 35.5%, respectively), and this effect persisted through the second year. In addition, factors such as age, sex, race/ethnicity, body mass index (BMI), and disease-related characteristics did not affect the positive outcome of the intervention. No differences were seen between the 2 groups with regard to hospitalizations, emergency department (ED) visits, after-hours visits, beta 2-agonist use, or primary care visits, however (Bender BG, et al. JAMA Pediatr. 2015;169[4]:317-323).

Commentary

This study shows a statistically significant improvement in adherence but still not a great result. Even in this well-insured, select population, only 44.5% of patients used their preventive medication every day. The good news is that these researchers developed a creative use of readily available technology to improve care and outcomes without significantly increasing cost or burden of work for the provider. A series of similar interventions directed at asthma and other chronic diseases may add up to huge improvements in overall health outcomes. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.