Inhaled corticosteroids (ICS) are highly effective medications for treatment of asthma in adolescents and young adults (AYA), yet in this age group the adherence rate for ICS at best is 50% and poor inhaler technique is present in 60%. Poor adherence results in asthma exacerbations leading to increased healthcare costs. Medication therapy management (MTM) is a structured, individualized approach to optimize health outcomes through improved medication use and is legislated through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003; over 600 programs exist. Typical MTM consultations occur by telephone, and less often, in a community pharmacy setting. Neither setting is optimal for patients with asthma as telephone encounters lack the visual interaction needed for observing and teaching inhaler technique and most pharmacies lack privacy for the consultation. The increased use of video telehealthcare (VT) and the pervasive use of smart phones with cameras by AYA provide an opportunity to move MTM consultations into a private space. We propose a 12-month masked randomized trial in AYA 14- to 30-years old with poorly controlled asthma while receiving ICS to test a MTM VT intervention plus electronic adherence self-management (EAM) (using CareTRx sensors and mobile application), versus EAM alone to measure ICS adherence and asthma health outcomes and determine cost-benefit. ICS adherence and albuterol use will be tracked in real time using CareTRx, which is novel and will improve the accuracy and relevance of adherence data. Our preliminary data indicate that inhaler technique training can be achieved effectively during VT and families like the convenience of VT. Our long-term goal is to develop a tailored, effective, and sustainable MTM VT intervention to improve asthma medication adherence and health outcomes in AYA. The American Lung Association Airways Clinical Research Centers will conduct the trial. The University of Florida Center for Quality Medication Management, the largest academic MTM provider in the nation, will conduct the MTM VT encounters. The UF Department of Pharmaceutical Outcomes and Policy will conduct the cost-benefit analysis. Use of existing MTM infrastructure to conduct a meaningful tailored VT asthma adherence intervention adds feasibility for expansion to other MTM programs around the country. We hypothesize that MTM VT plus EAM will improve adherence and prolong the time to asthma exacerbations compared to EAM alone.
Our Specific Aims are to: (1) identify themes unique to AYA that will inform a tailored approach for MTM VT; (2) test the hypothesis that MTM VT improves health and medication outcomes in a randomized clinical trial; (3) test the hypothesis that MTM VT reduces asthma health care costs. The results of this innovative project are important because MTM VT is a viable alternative to patient and provider interaction by phone or in a community pharmacy and analyzing the cost-benefit is essential to evaluating sustainability. MTM are established programs that can provide continuity of medication care as the AYA population transitions into adulthood and independence for their healthcare management.
Project Relevance Poor adherence to medications can result in adverse health outcomes. Using video telemedicine, adolescents and young adults with poorly controlled asthma will have adherence counseling with a pharmacist in a convenient and private location and be monitored for improvements in asthma outcomes. The results of this proposal will be applicable to patients with respiratory disease who require adherence counseling and would prefer to have visits in a private setting of their choice.
