According to the Centers for Disease Control and Prevention (CDC), more than 60 percent of adults with asthma have poor asthma control, with the lack of adequate access to physicians for asthma care as one of the contributing factors. CirrusMD conducted a study to determine if patients with access to virtual care physicians could improve their asthma control.
CirrusMD performed a retrospective, observational study within a population of asthma patients who had access to primary care physicians through a secure, text messaging platform to manage asthma care. Baseline and follow-up Asthma Control Test (ACT™) questionnaire scores were used to measure asthma control. The Wilcoxon Signed-Rank statistical analysis was used to determine the before and after differences in ACT scores for each patient. The paired T-test was used to determine the Effect size and P-values.
The patients displayed significant improvement to their asthma control and management. The average initial ACT score was 11.4 (range 6-19; 95% CI: 9.8, 13.0). The average final ACT score was 17.7 (range 6-24; 95% CI: 15.8, 19.5). The average difference between the initial and final ACT scores was 6.3 (95% CI: 4.2, 8.3). The ACT score difference was highly significant with a large Effect size of 1.22 and a P-value of < 0.0001.
This study demonstrated that asthma patients managed by primary care physicians using a virtual care modality can significantly increase the control of their asthma as measured by their ACT scores.
During the study period, 27 patients completed both the initial ACT score and at least one follow-up ACT score 28 or more days after the initial assessment (after censoring 3 patients who had upper respiratory infections). The average age of the patients was 33.3 years, with females comprising 74.1% of the participants. The average time between the initial and final ACT score determination was 42.1 days (range 28-91 days).
The average initial ACT score was 11.4 (range 6-19; 95% CI: 9.8, 13.0). The average final ACT score was 17.7 (range 6-24; 95% CI: 15.8, 19.5). The average difference between the initial and final ACT scores was 6.3 (95% CI: 4.2, 8.3). The ACT score difference was highly significant with a large Effect size of 1.22 and a P-value of < 0.0001.
Twenty-five patients had an initial ACT score ≤17. These patients had an average ACT score of 10.8 (95% CI: 9.4, 12.3) and a final ACT score of 17.5 (95% CI: 15.5, 19.5). The average ACT difference was 6.6 (95% CI: 4.5, 8.8. The Effect size was 1.3 and P-value < 0.0001.
Twenty-three of the 27 (85.2%) patients had a change in their asthma medication, based on asthma treatment standards. These changes included: 17 patients had an asthma controller medication added, switched, or dose increased, one patient had a controller medication added along with a nicotine replacement medication, two patients had a leukotriene medication added, three patients had the addition of both a controller medication and a leukotriene medication, and four patients had no medications additions or changes and were encouraged to use their controlled medication regularly.
As this study demonstrated, patients using a virtual primary care modality can significantly increase the control of their asthma as measured by their ACT scores during a one-to-three month time period. Patients reported feeling much better overall, which should positively impact continued adherence to the prescribed treatment regimen. Additional research is needed to determine if virtual care management of asthma patients translates into long-term asthma control.
Asthma Control Test (ACT)
Used by permission from GlaxoSmithKline
Abbreviations: ACT: Asthma Control Test, CI: confidence interval, COVID-19: Corona Virus Disease 2019 caused by SARS-CoV-2
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Authorship Confirmation Statement
T.E.P. conceived of the study and study design. S.C.H. oversaw data collection. T.E.P. performed the statistical analyses. T.E.P. and S.C.H. discussed the results and wrote the final manuscript.
We wish to thank Donna Baldwin, DO, Chief Quality and Innovation Officer for CirrusMD, Elishia M. Oliva, MD, Medical Director, CirrusMD, and Justin Chang, MD, Vice President of Provider Network, CirrusMD, for supporting this project and for their suggestion to improve the manuscript.
The authors have no conflict of interests.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
There have not been any prior presentations of the material.