Remote Patient Monitoring Effectively Assures Continuity of Care in Asthma Patients during the COVID-19 Pandemic

Abstract

Background

Digital health tools to bridge gaps in managing infectious pandemics was a proposition grounded, until recently, more hypothetically than in reality. The last 2 years exposed the extraordinary global need for robust digital solutions.

Objective

Determine the ability of remote patient monitoring (RPM) during the COVID-19 (coronavirus disease) pandemic to improve clinical outcomes and assure continuity of care in patients with asthma.

Methods

A total of 102 patients with asthma were enrolled in a telemonitoring protocol at the beginning of the COVID-19 pandemic in the United States. Intervention combined health coaching telephone calls and remote telemonitoring at a private, university-affiliated, outpatient clinical adult, and pediatric allergy/immunology and pulmonary practice. Patients enrolled with the primary rationale of maintaining continuity of care in the face of uncertain clinical care options. Enrollment and data collection proceeded in a fashion to allow detailed retrospective analysis. Telemonitoring included a pulse oximeter linked to a smartphone using the software platform Plan-it Med (PIM) ^®. A healthcare professional monitored data daily, and patients were contacted by providers due to vital sign abnormalities and treatment plan alterations. Patients were encouraged to remain on the platform daily during the first 3 months of the pandemic. After respiratory and/or clinical stability was achieved and clinic visit opportunities were resumed, patients were encouraged to maintain engagement with the platform but were not expected to use the platform daily. Asthma control test (ACT) scores were recorded before and after 6 months. Paired Wilcoxon signed-rank tests (dependent groups, before vs. after) and Wilcoxon rank-sum (Mann–Whitney) tests were performed for unpaired results (independent groups, RPM vs. control).

Results

Among 102 patients 19 had physiological abnormalities detected (18.6%). Eight of these 19 patients had actionable changes in prescription regimens based on RPM findings (42.1%). In patients utilizing RPM, there was a reported decrease in shortness of breath episodes and decreased need for rescue inhalers/nebulizer medications ( P = 0.005). Daily engagement in the first 3 months of the protocol was 61%. Subset analysis revealed 48 study participants (47.1%) chose to continue to actively use the program for at least 14 months. RPM patients ( n = 54) were 99.1% compliant with RPM after 110 patient months. Among patients who discontinued the RPM program, reasons included: 1) symptom alleviation (41.7%), 2) out-of-pocket costs to patients (38.9%), and 3) difficulty using the RPM program (16.7%).

Conclusions

Telemedicine is a valuable adjunct to face-to-face visits for asthma care. A novel RPM technology positively impacted continuity of care, asthma outcomes, quality of life, and self-care. Remote therapeutic monitoring offers great promise as a diagnostic tool and therapeutic intervention to improve adherence for patients with difficult-to-control asthma.