Telecommunications Enhanced Asthma Management (TEAM)

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DESCRIPTION (provided by applicant): We propose a practical, randomized clinical trial to test the impact of a health communication intervention designed to improve inhaled asthma controller medication adherence in 3-12 year old children with asthma in Kaiser Permanente of Colorado (KPCO), the largest health maintenance organization in the state. The Telecommunication Enhanced Adherence Management (TEAM) intervention is designed to increase communication with and support of pediatric patients and their parents by using automated telecommunication technology to: 1) allow parents more easy access to caregivers, 2) provide an immediate opportunity to request refills and inquire about their child's symptoms, and 3) provide educational and motivating messages about the importance of the child's daily asthma medication. This health- communication intervention will be delivered through state-of-the-art speech recognition (SR) technology. Advances in SR technology have made computer-generated conversation easier and more acceptable to respondents, and allow for correct interpretation of parents' spoken responses that in turn can lead to a range of appropriate SR responses. The investigative team has extensive experience using automated telecommunication technology to promote health-enhancing behavior change. The Benefit-Risk Model and Social Marketing Theory continue to guide both the objective and process of the intervention. Prospect Theory complements these and will guide development of the motivating messages to be contained in the SR intervention. This will be a Practical Clinical Trial aimed at the entire population of KPCO parents of a child receiving an inhaled corticosteroid (ICS) for asthma. It is expected that the 12-month TEAM intervention will increase ICS refill persistence and medication adherence (primary outcome) sufficient to produce significant improvement, relative to the usual-care control group, in asthma-related health outcomes as reflected in frequency of urgent care visits, prednisone use, beta2agonist use, and parent-reported symptom control and quality of life (secondary outcomes). A sub-study will randomly sample 200 families, both before and after participation in the TEAM intervention, to gather information about variables that may moderate the effectiveness of the intervention including race, socioeconomic status, illness severity, family structure, and benefit-risk perception. The presumption that prescription refilling is an accurate measure of adherence will be tested in a second sub-study that will use electronic devices to track ICS adherence. This system- based intervention has been designed using the RE-AIM framework so that it should have high reach and be consistently implemented at modest cost, and if effective, it can be maintained within KPCO as well as readily exported to other clinical healthcare settings