Tiny Chip Trips Up Non-Compliant Asthmatics


Vol. 14 •Issue 22 • Page 7
Tiny Chip Trips Up Non-Compliant Asthmatics * Tiny Chip Trips Up Non-Compliant Asthmatics

By Francie Scott

The doctor is puzzled when he is paged to the emergency room to attend an asthma patient. He has spent time educating this woman about the role of inflammatory medication and inhaler technique. She knows how to read a peak flow meter and boost her medication doses before she approaches the danger zones.

The patient assures the doctor she has followed the protocol, but he later discovers she had lied. She had not taken the anti-inflammatory medication in three days.

How did the doctor learn the truth?

He had some help from the computer chip attached to the woman’s inhaler. When he downloaded the data, he had an accurate picture of her medication schedule.

David Thrasher, MD, who practices pulmonary medicine in Montgomery, Ala., relates to the above scenario. He learned that many of his patients had not mastered the technique for activating an inhaler, in spite of his best efforts, when he started evaluating them with the MEDILog two months ago.

“This enables us to tell that they are not taking their medications when they should be taking them; if compliance dramatically improves, we’ll be able to keep people out of the emergency room,” he said.

Telemonitor tattling helps caregivers identify non-compliant patients who take shortcuts with their disease management and end up in trouble. Devices like the MDILog, developed by the Denver-based company, WestMed, may sound a little like Big Brother, but it records a wealth of data to help caregivers monitor their patients. The chip, housed in a sleeve that fits over the inhaler, records the patient’s technique.

It can tell whether patients shake the canister before inhaling, how long they used the inhaler, whether they inhaled with activation and whether or not they held their breath at the end of the cycle.

“Many of them have such terrible techniques they might as well not use it,” said Lee Ledbetter, CEO of Atlanta-based LifeOutcomes, a majority owned division of WestMed which will market the telemonitoring devices. “We really feel strongly that building better habits and better compliance will enhance patients’ lifestyles.”

The SpiroLog records a patient’s peak flow readings and is especially useful in helping physicians manage unstable asthmatics. Physicians are also able to evaluate the benefits of the medication by matching data from the MDILog and the SpiroLog.

DOWNLOADING DATA

Both devices can be downloaded from the patient’s home to a station in the physician’s office where the data is printed out in a user-friendly format. The doctor can see the clinical picture at a glance. Ledbetter explained that patients plug a modem into their telephone jacks and the data automatically download.

Ledbetter offers some dramatic statistics to support the computer surveillance of asthma care.

If asthma patients took their long-term beta agonists and steroids according to their prescriptions, 95 percent of them would never have an exacerbation of the disease, he maintains. Unfortunately, patients are notorious for non-compliance and poor inhaler technique, two habits that severely limit the amount of medication they receive. Patients with severe asthma frequently skip their daily dose of anti-inflammatory medication–they don’t feel better when they take a puff from that inhaler, favoring the short-term bronchodilator that helps them breathe when their chests feel tight.

The result: millions of dollars spent needlessly on emergency room visits, hospitalization and extra physician visits, not including loss of productivity, explained Ledbetter.

LifeOutcomes is working with two pulmonary practices–one in Montgomery, Ala., and one in Columbia, S.C.–to test the devices for marketing. WestMed already has clearance from the Food and Drug Administration to sell both devices, but Ledbetter is looking for strong data indicating improved outcomes and cash savings in health care costs to justify reimbursement for the computer chip feature.

Pharmacist Mike Blakely, who works with Carolina Pulmonary Associates in Columbia, said he and his team have screened 121 asthma patients older than 18 years to determine their inhaler technique. These patients are currently being enrolled in a clinical trial to evaluate asthma management.

LOTS OF PROBLEMS

Overall, he noted, “technique is poor,” and patients who take the correct doses of medication may be losing 70 percent of the drug because they do not operate their inhalers properly.

Patients will enter one of three groups and will rotate through four-month cycles. One group will receive asthma management education in addition to training on the devices and feedback from them; one group will be trained on the devices and get feedback but no additional education; and one group will not receive any feedback from the computer devices or any education.

Investigators are especially interested in the relationship between compliance and outcomes. Blakely suggested that non-compliant patients may begin to deteriorate because they are not getting the medication they need to stay stable.

Ledbetter looks forward to reviewing the data and developing a marketing plan for the computerized devices because he feels he has something to offer the three parties involved in asthma care: physicians can develop better management plans, patients stand to gain a better quality of life and the technology should appeal to third-party payers by driving down the cost of providing asthma care.

“It’s a win-win situation,” he said.

You can reach Francie Scott at fscottnz@ email.msn.com.

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