Health provider perspectives of electronic medication monitoring in outpatient asthma care: a qualitative investigation using the consolidated framework for implementation research

Abstract

Objective

Little is known about the implementation challenges health providers might face with the use of digital health in outpatient asthma care. To qualitatively explore the experience of health providers with electronic medication monitoring (EMM) using an implementation science framework.

Methods

Using the Consolidated Framework of Implementation Research (CFIR), we conducted interviews (n = 10) exploring health providers’ experience with EMM with asthma patients from 5 primary care or specialty clinics. The EMM tracked albuterol and inhaled corticosteroid (ICS) use, and health providers called parents whenever ICS adherence waned, or albuterol use increased. Interviews were audio-recorded, transcribed, and deductively analyzed using directed content analysis.

Results

Health providers reported the intervention’s primary advantage, compared with current asthma care, was the ability to monitor medication use at-home. Most felt the intervention improved care delivery. Nurses and medical assistants described a process of phone calls and checking alerts, that had varying levels of administrative burden and complexity. Health providers felt that sustained implementation of the intervention model would require additional employees to handle the administrative and clinical workload. Half of the interviewed providers were unsure if patient needs were met by the intervention, while some cited technology syncing issues, others liked the enhanced interactions for asthma education.

Conclusion

Health providers reported positive experiences supporting parents and children with asthma using EMM but also highlighted intervention components that needed improvement or refinement to yield successful implementation in outpatient pediatric clinics. Recommendations for enhancing the intervention for a scaled-up implementation were discussed.

Keywords:

• Mobile health
• pediatric asthma

Declaration of interest

Dr. Gupta reports receiving grants from Rho Inc., Stanford Sean N. Parker Center for Allergy Research, Thermo Fisher Scientific, Genentech, and the National Confectioners Association; she also serves as a medical consultant/advisor for Before Brands, Kaleo Inc., Genentech, DOTS Technology, Aimmune Therapeutics, DBV Technologies, and DOTS Technology.

Additional information

Funding

Dr. Kan and this study is supported by the Agency for Healthcare Research and Quality [5K12HS026385]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The Improving Technology-Assisted Recording of Asthma Control in Children Trial was funded by UnitedHealth Group.