This is a randomized trial designed to examine the effect of participant designed medication reminders via text messaging on asthma control and adherence. It is a collaborative effort with the Adherence Center.
- Total planned population is 230 patients.
- Current participants enrolled is 33.
- Patient response has been very favorable to text message reminders to take their asthma medication.
Cohort Interventions for Patients with Persistently Not Well-Controlled Asthma
The team continued to maintain its high level, evidence-based medical and behavioral care, leading to the development of the Teen Health Center’s Epic asthma work. By year end 54.2% of patients had achieved good asthma control.
The efforts around this initiative were intended to understand why patients’ asthma was not well controlled and develop interventions to help improve their control.
- Over this year, control scores improved 60% for patients, compared to 25% the prior year.
- Interventions included vigorous contact (phone, texting, schools), tracking and coordinated delivery of available evidence-based care (trigger avoidance, skill development, treatment of co-morbidities).
- Our upcoming focus will be on failure analysis for patients that did not improve and implementing processes outside of our cohort population.
Through clinical experience and more formal research methods (User Centered Design), the team recognized the impact hardships (i.e., financial, mental health) had on asthma management. Working with our patients and social services from across the hospital, we determined that inability to obtain needed medications, transportation problems, and mental health problems were the most prevalent and serious problems affecting families’ ability to meet medical needs. Therefore, we selected three major areas to address:
- In collaboration with community agencies we clarified processes and developed algorithms and tools to enhance the success of mental health referrals. By January 2011, the lab was implementing these processes with >95% reliability. The tools and processes were spread to the entire Teen Health Center.
- The team investigated medical transportation options available through insurance and public sources. In collaboration with families, we developed a simple brochure that explains their benefits and delivered it with 95% reliability to all eligible patients. It was then made available throughout Cincinnati Children's.
- We worked with financial counseling and the pharmacy to clarify requirements and improve processes for obtaining medication when families lacked coverage. We systematically identified patients without medication coverage and successfully obtained medication for all patients in need. In addition, Financial Counseling extended its hours to ensure availability to the end of the clinic day.
Improving flu vaccination for patients who do not have appointments
- In previous years, we immunized >98% of patients who made any visits to the clinic during the fall immunization window. Nearly all patients who remained unimmunized could not be contacted despite multiple attempts, mostly due to lack of current address and phone number.
- This year we developed processes to obtain and record in Epic extended contact information (multiple numbers, email addresses, etc.). This enabled us to reach more families, and the overall rate for our population increased to 86%
- This additional information also added our ability to contact families for other follow-up and care coordination needs.