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

15 May 2023
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

Resource information

Respiratory conditions
  • Asthma
Respiratory topics
  • Disease management
  • Technology
Type of resource
Munich 2023
Md Nazim Uzzaman1,3, Vicky Hammersley1, Kirstie McClatchey1, Jessica Sheringham2, Monsur Habib3, Hilary Pinnock1 1The University of Edinburgh, Edinburgh, United Kingdom, 2University College Hospital, London, London, United Kingdom, 3Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh