title: Pragmatic trial of health care technologies to improve adherence to pediatric asthma treatment: a randomized clinical trial.
abstract: OBJECTIVE
  Most patients with asthma take fewer than half of prescribed doses of controller medication. Interventions to improve adherence have typically been costly, impractical, and at best only minimally successful.
  
  
  OBJECTIVE
  To test a speech recognition (SR) intervention to improve adherence to pediatric asthma controller medication.
  
  
  METHODS
  The Breathe Well study was a 24-month pragmatic randomized clinical trial. The study was conducted within Kaiser Permanente Colorado, a large, group-model health maintenance organization. A total of 1187 children aged 3 to 12 years with a persistent asthma diagnosis and prescription for an inhaled corticosteroid were randomized to the computerized SR intervention or usual care condition and followed up for 24 months between October 2009 and February 2013.
  
  
  METHODS
  Speech recognition telephone calls to parents in the intervention condition were triggered when an inhaled corticosteroid refill was due or overdue. Calls were automatically tailored with medical and demographic information from the electronic health record and from parent answers to questions in the call regarding recent refills or a desire to receive help refilling, learn more about asthma control, or speak with an asthma nurse or pharmacy staff member.
  
  
  METHODS
  Adherence to pediatric asthma controller medication, measured as the medication possession ratio over 24 months.
  
  
  RESULTS
  In the intention-to-treat analysis, inhaled corticosteroid adherence was 25.4% higher in the intervention group than in the usual care group (24-month mean [SE] adherence, 44.5% [1.2%] vs 35.5% [1.1%], respectively; P < .001). Asthma-related urgent care events did not differ between the 2 groups. The intervention effect was consistent in subgroups stratified by age, sex, race/ethnicity, body mass index, and disease-related characteristics.
  
  
  CONCLUSIONS
  The intervention's significant impact on adherence demonstrates strong potential for low-cost SR adherence programs integrated with an electronic health record. The absence of change in urgent care visits may be attributable to the already low number of asthma urgent care visits within Kaiser Permanente Colorado. Application of electronic health record-leveraged SR interventions may reduce health care utilization when applied in a population with less-controlled asthma.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00958932.
authors: Division of Pediatric Behavioral Health, National Jewish Health, Denver, Colorado2University of Colorado, Denver.
authors: Bruce G
authors: BG
authors: Bender
authors: Kaiser Permanente Colorado Institute for Health Research, Denver.
authors: Peter J
authors: PJ
authors: Cvietusa
authors: Kaiser Permanente Colorado Institute for Health Research, Denver.
authors: Glenn K
authors: GK
authors: Goodrich
authors: Kaiser Permanente Colorado Institute for Health Research, Denver.
authors: Ryan
authors: R
authors: Lowe
authors: Kaiser Permanente Colorado Institute for Health Research, Denver.
authors: Heather A
authors: HA
authors: Nuanes
authors: Johns Hopkins Medical School, Baltimore, Maryland.
authors: Cynthia
authors: C
authors: Rand
authors: Kaiser Permanente Colorado Institute for Health Research, Denver.
authors: Susan
authors: S
authors: Shetterly
authors: Kaiser Permanente Colorado Institute for Health Research, Denver.
authors: Cathy
authors: C
authors: Tacinas
authors: Kaiser Permanente Center for Health Research Northwest, Portland, Oregon.
authors: William M
authors: WM
authors: Vollmer
authors: Kaiser Permanente Colorado Institute for Health Research, Denver.
authors: Nicole
authors: N
authors: Wagner
authors: Division of Pediatric Behavioral Health, National Jewish Health, Denver, Colorado2University of Colorado, Denver.
authors: Frederick S
authors: FS
authors: Wamboldt
authors: Kaiser Permanente Colorado Institute for Health Research, Denver.
authors: Stanley
authors: S
authors: Xu
authors: University of Colorado, Denver3Kaiser Permanente Colorado Institute for Health Research, Denver.
authors: David J
authors: DJ
authors: Magid
mesh_terms: D000280:Administration, Inhalation; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D055118:Medication Adherence; D010290:Parents; D017010:Reminder Systems; D049250:Speech Recognition Software; D017216:Telemedicine; D013689:Telephone
chemical_list: D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids