Controller adherence following hospital discharge in high risk children: A pilot randomized trial of text message reminders

ABSTRACT

Objective: To assess the feasibility of a mobile health, inhaled corticosteroid (ICS) adherence reminder intervention and to characterize adherence trajectories immediately following severe asthma exacerbation in high-risk urban children with persistent asthma. Methods: Children aged 2–13 with persistent asthma were enrolled in this pilot randomized controlled trial during an asthma emergency department (ED) visit or hospitalization. Intervention arm participants received daily text message reminders for 30 days, and both arms received electronic sensors to measure ICS use. Primary outcomes were feasibility of sensor use and text message acceptability. Secondary outcomes included adherence to prescribed ICS regimen and 30-day adherence trajectories. Group-based trajectory modeling was used to examine adherence trajectories. Results: Forty-one participants (mean age 5.9) were randomized to intervention (n = 21) or control (n = 20). Overall, 85% were Black, 88% had public insurance, and 51% of the caregivers had a high school education or less. Thirty-two participant families (78%) transmitted medication adherence data; of caregivers who completed the acceptability survey, 25 (96%) chose to receive daily reminders beyond that study interval. Secondary outcome analyses demonstrated similar average daily adherence between groups (intervention = 36%; control = 32%, P = 0.73). Three adherence trajectories were identified with none ever exceeding 80% adherence. Conclusions: Within a high-risk pediatric cohort, electronic monitoring of ICS use and adherence reminders delivered via text message were feasible for most participants, but there was no signal of effect. Adherence trajectories following severe exacerbation were suboptimal, demonstrating an important opportunity for asthma care improvement.

Trial registration: ClinicalTrials.gov identifier: NCT02615743.

KEYWORDS:

• Mobile health
• inhaled corticosteroids
• medication adherence
• trajectory modeling

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Acknowledgements

We acknowledge Meredith Barrett, PhD (Propeller Health, Madison Wisconsin) for her review and comments on previous versions of this manuscript. The project described was supported in part by Grant Number UL1TR000003 from the National Center for Advancing Translational Science. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Science or the National Institutes of Health.

Additional information

Funding

This work was supported by the National Center for Advancing Translational Science (UL1TR000003) and the Institute for Translational Medicine and Therapeutics (ITMAT) at the University of Pennsylvania. The study sponsor was not involved in: (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the paper for publication. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.