SAN DIEGO – A newly developed computer program mines electronic medical records to find pediatric asthma patients who are about to run out of their inhaled corticosteroid inhalers, then calls their parents to help them order new ones.
It’s not a robocall. Parents don’t push buttons to signal their response. Instead, they speak to the computer, and it understands what they say, just like the automated speech-recognition telephone systems used by credit card companies, airlines, and other industries. The software was developed by team from National Jewish Health and Kaiser Permanente Colorado, both in Denver.
Dr. Bruce Bender
At 24 months, adherence – measured by medication possession ratio – was 44.5% among 452 children randomized to the calls and 35.5% among 447 who were not, a statistically significant 25% difference.
"It takes a fair amount of work to get a system like this going, but then the computer does the rest. Most adherence interventions expect busy health care providers to do something; this doesn’t add any burden to their day. Think of it as the electronic health record picking up the phone and talking with patients," said project leader Bruce Bender, Ph.D., head of pediatric behavioral health at National Jewish Health in Denver.
The system calls parents 10 days before the child is due to run out of the inhaler. "It pulls information out of the EHR, so when it talks to the parent, it references the prescribing physician, the name of the child, and the last time the inhaled corticosteroid prescription was filled." It then gives parents options to refill the prescription or talk with an asthma nurse or pharmacist, among other things, he said.
The 25% adherence improvement was consistent throughout the investigation and in subgroups stratified by age, gender, race, body mass index, or disease-related characteristics.
ED visits and admissions did not differ between the call and control groups. "We were a little bit surprised by that, because this is a bigger bump in adherence than you typically see in adherence interventions." Maybe it was because "care is already pretty good in [our system]; we keep people out of the ED pretty effectively." In both groups, there were 0.09 ED visits per person in the year before enrollment, Dr. Bender said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
"It could also be that in asthma, you really need to change the [adherence] curve more dramatically to see a change in outcomes," he said.
Children in the study were aged 3-12 years. About 10% of parents contacted declined to participate in the program; about 90% of those who did said in subsequent surveys that they liked the calls and found them helpful. Dr. Bender and his colleagues said they hope to scale up the system for cardiovascular and adult asthma patients.
If parents did not pick up the phone, the system would leave a message and try a few more times, but "we capped it at three [callbacks]. We didn’t want people to feel harassed," he said.
Eliza Corp., a computer company outside of Boston, developed the program’s software. The efforts were funded by the National Heart, Lung, and Blood institute. Dr. Bender said he has no relevant disclosures.