Using a Novel Technology to Improve Adherence: School-Based Asthma Treatment

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DESCRIPTION (provided by applicant): This application addresses the broad Challenge Area (06) Enabling Technologies, and specific Challenge Topic, 06-OD(OBSSR)-101*: Using new technologies to improve or measure adherence. We propose the development and testing of a novel technology to improve adherence to effective preventive asthma medications and reduce morbidity among young urban children. While NHLBI guidelines recommend daily maintenance medications for all children with persistent asthma, studies indicate that poor adherence is common, and many children in the US who should receive preventive medications are not receiving them. The goal of this new translational project is to test the feasibility and effectiveness of implementing directly observed therapy of preventive asthma medications in school in a real-world setting, using state-of-the-art web-based technology for systematic screening, electronic report generation, and communication between nurses, caregivers, and primary care providers. This study builds on our experience with a prior study of 530 children that demonstrated that school-based administration of preventive asthma medications improves asthma symptoms and reduces absenteeism. In order for this program to have sustainable public health impact, we must now develop the technology for systematic screening and communication in order to integrate it within the school and community systems that serve these high risk children. We propose a two-year study to develop an integrated system for the sustained delivery of preventive asthma medications in schools using web-based technology (year 1), and to conduct a pilot randomized trial to evaluate the feasibility and preliminary effectiveness of the intervention on asthma morbidity, including symptom-free days, quality of life, absenteeism, and urgent health care use (year 2). We also will evaluate the added cost to implement and sustain this new system of care. In the first year, we will develop the technology for this new system of care and refine the intervention using expert consultation with key informants and focus group methodology. The second year will consist of a randomized trial to test this model of care with 80 students from 12 inner-city schools. We hypothesize that this novel adaptation of school-based asthma care will; 1) be feasible and acceptable among this population and among school and community personnel, and 2) yield reduced asthma morbidity (symptom-free days, absenteeism, and emergency room / urgent care use for asthma care). There currently are no practical, system-wide interventions for urban children with asthma that assure that children take the medications they should be receiving. The proposed intervention could have a major public health impact as a model for asthma care in communities nationwide to improve outcomes and reduce disparities. Further, it provides the opportunity to substantially accelerate the diffusion of a novel method to improve adherence and subsequently reduce morbidity, without interruption of a highly successful community-based collaboration. - RELEVANCE There currently are no practical, system-wide interventions for urban children with asthma that assure that children are receiving appropriate preventive care. Importantly, effective asthma therapies will not work if they are not used by the patients who need them. This intervention is designed to implement guideline- based asthma care through an innovative program in the city schools. This project may have a profound impact on public health because it presents a practical system change utilizing technology to promote adherence to effective asthma care guidelines. Our prior data suggest that the proposed school-based asthma intervention could produce significant reduction in morbidity for minimum cost. This program has the potential to serve as a model for improved asthma care in urban communities nationwide.