Vol. 14 •Issue 1 • Page 18
Allergy & Asthma
Asthma Education Goes High-tech With Interactive Computerized Tools
Numerous studies document the deteriorating health of patients with chronic diseases when they aren’t informed or involved in the management of their care. While many patients want to learn, as practitioners and educators we’re often faced with the challenge of providing an effective and efficient approach to patient education.
Interactive computerized approaches to asthma management are evolving, and they oftentimes become powerful tools to support the health care learning process. Computer-based strategies such as simple tutorials, interactive videos, CD-ROM programs and Internet applications are being employed outside of health care settings as a supplement to conventional asthma care.
Various studies have demonstrated that this type of technology may reduce morbidity, improve quality of life, and enhance asthma management. For example, researchers have demonstrated the validity of spirometry self-testing with an Internet-based home asthma telehealth system within a group of urban asthma patients with no computer background or skills.1
In another study, researchers demonstrated that caregivers in a virtual education group had an increase in patients’ quality-of-life survey scores, infrequent use of rescue therapy, and a high rate of satisfaction with home telemonitoring.2
CREATING AN ASTHMA GAME
Organizations and institutions continually are recognizing the importance of computer technology as a learning and educational strategy. I’ve had the pleasure of working with the Starlight Starbright Children’s Foundation. This organization is creative and innovative in the use of technology-based interventions for children and adolescents with chronic diseases.
One of the ways it helps children is by emphasizing empowerment and the development of management skills in an entertaining and age-appropriate manner using interactive educational games. The foundation quickly recognized the need for this type of tool for children with asthma and their families.
In 1999, the Starbright Foundation assembled an interdisciplinary team of five national pediatric asthma experts, of which I was a member. Our job was to serve as consultants and advisers in the development of an asthma CD-ROM game based on current pediatric guidelines and best practices. The team consisted of two allergists, a pediatric psychologist, a pediatric pulmonary nurse practitioner, and myself, a health educator/asthma educator.
Each member contributed to the 18-month process by developing goals and modules for the game and related scripts. My role was to give feedback on the educational modules that reflected key self-management skills and behaviors that children need to learn to control asthma. Because I counsel predominately inner-city patients, it also was important that I provide my perspective and input on the psychosocial issues, environmental challenges and additional barriers that affect the management of the disease for urban families.
The team had to be cohesive and committed to the process. Face-to-face meetings, scheduled conference calls, and numerous e-mails were essential to the creation of this product. It was a challenging but exciting process, and it was also a tremendous responsibility. It was always in the back of my mind that we had to get this right because the game would have a huge impact on children and families throughout the country.
Having reviewed a number of educational tools for use in my practice, I knew there was a lack of truly interactive, inexpensive games that could assist children and parents in a realistic and practical manner, especially for the inner-city population. When Starbright’s asthma CD-ROM game Quest for the Code™ was completed, I felt it was a great extension to the services I provide in the office, sort of like taking a piece of me home.
URBAN ASTHMA PORTAL
My journey into the world of interactive asthma computer approaches continues with my current project at Howard University College of Medicine and Howard University Telehealth Sciences and Advanced Technology Center in Washington, D.C. We’re in the process of developing an urban asthma portal.
The purpose of the portal is to make asthma care accessible by bringing it to community institutions and homes of urban patients at risk for the complications of asthma. It gives new meaning to the phrase “community house calls” in the information age.
Patients will have the opportunity to interact on a regular basis with their asthma counselor, and in some cases their asthma specialist, during real-time virtual sessions. We’ve long recognized the importance of the asthma counselor as an integral component in the management of asthma, especially for inner-city families. The virtual extension of the asthma counselor service into the home and community will increase the Howard University Asthma Team’s ability to deliver asthma information and asthma care management to the underserved community, those least likely to have access to quality asthma care services.
The Howard University Asthma Portal is a dynamic, Internet-rich application that contains medical video conferencing, consultant/patient databases, news feeds, online medical instrumentation readings, education and training didactics. Some unique features of the asthma portal are:
• Real-time multipoint video conferencing over the Internet is done with no special hardware or software needed except for a Web cam.
• Online spirometer readings taken from a spirometer plugged directly into the patient’s home computer are captured to the patient’s online database file for consultant review.
• Direct patient observation with a combination of the video conferencing and the custom online patient database allows consultants to ensure that the device/inhaler is being used in the correct manner.
• Asthma educational information from news feeds gathered via the Web and materials published to the portal by the asthma team are pushed to the patient/consultant login overview screen.
• The personalized interface/greeting or patient login interface is much more than a simple welcome. It’s tailored to the individual patient and displays provider-to-patient reminder notices based upon consultant recommendations for medication, testing, online consults, etc.
• The online registration simplifies the registration process. Registration forms are stored online, allowing patients to fill in vital information that’s used by their doctor and asthma counselor to optimize their asthma action plan.
• The patient’s personalized asthma action plan is stored online for the patient/providers to view and evaluate. It can be referenced in real time in conjunction with spirometer readings and signal an alert to the patient when medication adjustments need to be made, as well as notify the consultant/physician.
We have selected two families to pilot our project. One family consists of three children with asthma ranging in age from 7 to 14. The second family is a mother and teenager. Both families are looking forward to the launching of this project, which is projected for February. We hope to find that our asthma portal concept will assist in reducing barriers and obstacles that exist in the complex inner-city environment and improve the quality of life for the patients and their families.
My overall experience with both projects has been positive and provided me with my first glance and new insights on the dynamic nature and usefulness of computer technology in asthma management. With the numerous obstacles families experience in managing asthma, the use of interactive tools is an approach we must continue to explore. We must keep in mind that the intervention must be appealing and engaging, accessible, inexpensive and realistic for the low-income rural and inner-city populations, as well as the general population.
Asthma continues to cause significant morbidity among children and adults.3 New and effective therapies are available, but we remain challenged in our efforts to combat this disease. Interactive asthma CD-ROM games such as the product developed by the Starlight Starbright Children’s Foundation and the urban asthma portal can be effective tools to improve asthma outcomes and assist in the development of asthma management skills.
1. Finkelstein J, Cabrera MR, Hripcak C. Internet-based home asthma telemonitoring: Can patients handle the technology? Chest. 2000;117(1):148-55.
2. Chan DS, Callahan CW, Sheets SJ, Moreno CN, Malone FJ. An Internet-based store and forward video home telesystem for improving outcomes in children. Am J Health Syst Pharm. 2003;60(19):1976-81.
3. Mannino DM, et al. Surveillance for asthma – United States, 1960-1995. MMWR. 1998;47(1):1-27.
Thornton is a research and health services administrator and director of community outreach for asthma care at Howard University College of Medicine, Washington, D.C. She can be reached at firstname.lastname@example.org. Ernest L. Carter, MD, PhD, director of the Telehealth Sciences and Advanced Technology Center at Howard University, made contributions to this article.