Asynchronous digital health interventions (aDHI) for reviewing asthma: a mixed-methods systematic review

Introduction: Little is known about how aDHI (for example, transmission of clinical data from patients online that allows a healthcare professional to review the data and provide feedback later) can support care for people with asthma. Aim: To review evidence of the effectiveness and acceptability of aDHI for reviewing asthma. Methods: We searched six databases (Jan-2001 to Jun-2022) for quantitative/qualitative studies on asynchronous asthma reviews. Screening and data extraction was duplicated. Analysis: meta-analysis of trial data, thematic analysis of qualitative data. Results: Of 11034 records identified in the search, 30 studies (20 quantitative; 8 qualitative; 2 mixed-methods) were eligible for inclusion. These originated from nine countries, 3428 people with asthma and/or caregivers and 140 healthcare professionals (HCPs). Frequently used digital functionalities were monitoring diaries (n=14), control assessments (n=10), action plans (n=7), automated feedback (n=7), and medication reminders (n=4). Of these 71% used web-portals, 19% used mobile applications and 10% used SMS. Only three studies were linked with electronic health records (EHR). Compared to usual care, aDHI improved asthma control [SMD 0.27; 95% CI 0.03 to 0.52] and reduced hospitalisations [RR 0.37; 95% CI 0.14 to 0.96], but there was no significant difference in quality of life [SMD 0.15; 95% CI -0.20 to 0.51] or emergency department visits [RR 0.79; 95% CI 0.40 to 1.57]. Most patients and HCPs appreciated exchanging tailored messages, and described (user-friendly) two-way aDHI as reducing clinic visits and fitting their lifestyle/work though filling out questionnaires could be burdensome. Poorly co-ordinated workflows, lack of integration with EHR, workload and no financial reimbursement were barriers to using aDHI. Conclusions: aDHI can be an effective option or adjunct to other modes of consultations for reviewing non-emergency asthma patients. PROSPERO: CRD42022344224 Funding: NU has an Asthma UK Centre for Applied Research PhD studentship