Patients use Web video cameras to record themselves using their inhalers. They also receive electronic feedback from case managers via E-mail or videotape, including pointers on technique.
A recent study of children's health by the Centers for Disease Control and Prevention estimates that nearly 9 million children in the United States have been diagnosed with asthma, and that 4 million have had at least one asthma attack in the last 12 months. One hospital is showing how telemedicine can help these chronically ill children manage their conditions from their own homes.
Under the Asthma In-Home Monitoring project under way at Tripler Army Medical Center in Hawaii, researchers are evaluating care management of 120 asthmatic children, ages 6 to 17. The project, funded by the U.S. Army Medical Research Acquisition Activity, compares the cases of 60 children following traditional case-management procedures, including in-office clinical visits, with 60 children being monitored at home via virtual visits with case managers over the Web.
"Kids need to be reinforced on techniques," Tripler's Chan says.
The virtual patients use Web video cameras to record themselves using their inhalers. They take peak-flow breathing measurements with small devices that can help gauge how their lungs are doing, since allergies, cold viruses, pollution, and smoke can exacerbate the disease, says Dr. Debora Chan, a pharmacist and pediatric research project director at the department of pediatrics at Tripler Army Medical Center. The recordings, which involve patients holding their peak-flow devices up to the video cameras and reading the measurements aloud, are uploaded onto a secure Web site using store-and-forward technology. Four case managers, who are handling both the virtual and in-office kids, compare the two groups on 19 data points to determine the disease outcomes, adherence to therapy, cost-effectiveness, and patient attitudes toward case-management methods.
The virtual patients receive from their case managers electronic feedback, which can be E-mailed or videotaped, such as pointers on improving inhaler techniques. Each patient will participate in the study for one year. The project is expected to be completed by 2005.
The Asthma-In-Home Monitoring project is the second telemedicine project by Tripler involving asthmatic kids in Hawaii. An earlier, smaller project with 10 children found that the telehealth case management of children with persistent asthma resulted in improved therapeutic and disease-control outcomes as measured by inhaler technique and percentage of personal-best peak-flow values. This success was realized even though, during the six-month period, adherence to the requirement of sending daily asthma diary submissions and videos decreased, Chan says.
"That indicates that once kids develop good habits for managing their asthma, they're less inclined to submit the videos," Chan says. "Kids need to be reinforced on their techniques, especially during exacerbations, but once they learn good habits and adhere to them, they don't need us as much," she says.
Still, Chan recognizes that children's motivations to participate in the program aren't always born of the purest intentions. "Some kids are motivated because they just want to use the computer," she says, rather than because they realize the potential health risks of asthma. "Asthma is a huge disease, and unfortunately some don't understand that you can die of it," Chan says. For adults, she speculates, the potential appeal of at-home monitoring of chronic diseases might have less to do with the thrill of using a computer and more to do with an awareness of their own mortality.
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