A virtual asthma clinic for children
In chronic diseases like asthma, self-management plays a crucial role. Patients have to participate proactively in their own healthcare and improve their behavior accordingly to improve health outcomes. This growing burden of self-management calls for innovative approaches to provide and transform traditional healthcare. With respect to pediatric asthma, previous studies did only assess the added value of eHealth to standard care. It has not been investigated whether eHealth can (partly) replace usual care.
For this purpose, a virtual asthma clinic (VAC) for children was developed: a web-based portal accessible for registered children, their parents and their asthma team. It has 3 modules: (1) A chat and forum module; (2) an education module; (3) a secure and private module in which the patient or parent can log in, check their personal treatment plan and communicate easily and 24/7 with the asthma team.
In a randomized controlled multicentre trial online care using the VAC was compared with standard care. We aimed to assess whether asthma control could be improved by using the VAC while reducing outpatient visits by 50%. During 16 months, 210 asthmatic children (6-16 years) were randomized into usual care (UC) or cares using the VAC. Children in the UC group were seen every 4 months, while children in the VAC group were only checked 8-monthly but were monitored online with a monthly questionnaire (ACT) to assess asthma control. Besides ACT, the number of symptom free days (SFDs), quality of life, lung function (FEV1), asthma exacerbations, unscheduled outpatient visits, hospital admissions and daily dose of inhaled corticosteroids (ICS) were compared between both groups. Additionally, a cost-effectiveness analysis was conducted.
After 16 months, the number of symptoms free days and the degree of asthma control improved in children who received care using the VAC. No differences were seen in the other outcome measures. Besides improved health outcomes, care using the VAC resulted in significant cost savings; with a mean cost savings of €352 per patient. We concluded that the VAC is an effective eHealth innovation to improve asthma care and is cost-effective.
In 2015, we implemented the VAC in 14 hospitals in the Netherlands. In this project, which was funded by a grant from ZonMw, the drivers and barriers for implementation of this eHealth intervention were studied and an implementation manual to promote successful implementation was written. In 2016, collaboration with the Dutch Lung Foundation (national patient organization) resulted in the development of a mobile app for teenagers which will be launched in the first quarter of 2017. With this app, the VAC will be accessible on smartphone and tablet. In April 2017, the project ‘Betaalbaar Beter’ will start; an intensive collaboration with one of the Dutch largest health insurance companies (VGZ). This project strives to achieve better and more affordable care with high patient value. The VAC will be further implemented in The Netherlands and healthcare organizations will receive a structural financial compensation for this online monitoring, which is new in Netherlands.