Purpose:Asthma is one of the most common chronic diseases, affecting 20.4 million adults aged 18 and over in the United States (CDC, 2018b).Though patients are generally able to manage asthma with maintenance medications, they often experience exacerbations that may worsen without proper management (Gatheral et al., 2017). Alarmingly, 44.9%, or 9.1 million adult patients with asthma, report having one or more asthma attacks every year (CDC, 2018a). Patients with uncontrolled asthma are more likely to have missed days of work and school, as well as impaired quality of life, including: limitations in daily activities, decreased enjoyment of everyday life, increased feelings of frustration related to asthma symptoms, and decreased productivity at home, work and school (Marcano Belisario et al., 2013). The U.S. Department of Health and Human Services ([HHS], 2007), and Global Initiative for Asthma (GINA, 2018) recommend patient education and clinician follow-up, as well as the use of asthma action plans as strategies to improve patients’ ability to self-manage their asthma. Despite the strong evidence in support of self-management, most patients with asthma have not been provided with education on the importance of self-management, nor have they been provided a personalized asthma action plan (Pinnock & Thomas, 2015). In addition to education and asthma action plans, emerging research supports the use of mobile apps and digital media as an element of improved asthma control (Hui et al., 2017). The purpose of this project was to improve asthma control through the use of education and the implementation of a mobile application.
Sample: Implementation of the project occurred at a primary care office in Northwest Indiana, staffed by one nurse practitioner and one physician. Criteria for participation included a patients with a diagnosis of asthma, who have had medications prescribed for asthma within the last 12 months. Participants were asked about their asthma diagnosis and whether it was recent, whether they were currently using any medications for asthma, and whether they felt like they had ongoing issues with asthma. This clarification was made in order to prevent the inclusion of patients who may have been either erroneously diagnosed with asthma many years ago or as a child, or who do not currently utilize any form of asthma treatment. Patients who have asthma listed as a diagnosis in their medical charts, but deny ever being diagnosed with asthma will be excluded and encouraged to have further discussion with their primary care provider. Additional inclusion criteria included English speaking and in possession of and able to use a smartphone. Exclusion criteria included pregnant women and those diagnosed with dementia or significant cognitive impairment that would prevent the patient from accurately tracking symptoms or independently managing their health conditions.
Methods:The intervention was based on evidence that supports the importance of clinic-based education (HHS, 2007), as well as evidence regarding the use of mobile apps for improved asthma self-management (Marcano Belisario et al.,2013). The first component of the intervention included a 30-minute one-on-one asthma education session utilizing a patient education guide published by the CHEST foundation, titled “Living Well with Asthma.” This education guide was provided to the patient at no cost, and the content included topics such as: the disease-process of asthma and how it impacts the body, asthma triggers and solutions, following an asthma action plan, understanding asthma medications, inhalers and peak flow meters, and what to do in case of asthma attack. In addition to reviewing each page in the “Living Well with Asthma” booklet, patients were also encouraged to ask any questions they may have regarding the management of their asthma.The second component of the intervention included the use of a mobile application for asthma management. Patients downloaded a free smartphone application, AsthmaMD, onto their mobile phone. The project manager assisted the patient is entering their personal data such as height, weight and age, as well as inputting their maintenance and rescue medications as applicable. From this information, a digital asthma action plan was created by the mobile application. Patients were instructed on entering symptoms into the symptom tracker, setting up medication reminders, and following their asthma action plan if symptoms arise. Patients were instructed to log into the app and record their symptoms once per day. This included entering symptoms if they experienced any, or lack of symptoms if they didn’t, into the symptom tracker, tracking if they took asthma medications, and setting medication reminders if needed.
EBP Outcomes: In order to gauge improvement in asthma management, three outcomes were measured. Patient-reported asthma control were measured using the Asthma Control Test (ACT), which assesses frequency of shortness of breath and general asthma symptoms, use of rescue medications, effect of asthma on daily functioning, and overall self-assessment of asthma control. Patient-reported asthma-related quality of life was measured using the Asthma Impact Survey (AIS-6) which assesses the impact of asthma on everyday functioning, performance in usual daily activities, social functioning, emotional functioning and productivity at work or home. Asthma Literacy was measured using a four-item questionnaire designed by the project manager, aimed to evaluate patients’ knowledge of asthma and confidence in using an inhaler, identifying personal asthma triggers, and utilizing an action plan. Data was collected at baseline, and again four and eight weeks post-intervention to determine if the use an educational intervention coupled with the use of a mobile application and digital asthma action plan successfully improved patients’ asthma management.
Nursing Implications:There is a need for improved asthma self-management in the primary care setting. Providers can improve asthma self-management and therefore asthma control and asthma-related quality of life, by promoting education, written or digital asthma action plans, and the use of a mobile application for symptom tracking and medication reminders. As the use of technology increases especially in healthcare, the use of a mobile application can improve the way that healthcare professionals encourage patients to take control of managing their asthma symptoms.
Conclusions:EBP project is in progress, however improved asthma control, asthma-related quality of life, and asthma literacy is anticipated. If the use of an educational intervention in conjunction with the implementation of a mobile application improves asthma outcomes, primary care providers should utilize this method to improve their patients’ asthma self-management and control in order to prevent future exacerbations.
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