Asthma Clinical Trial
Official title:
Pre/Post Pilot Test of VME for the Video vs. TTG Respiratory Inhaler Technique Assessment and InstructioN Study
Asthma and Chronic obstructive pulmonary disease (COPD) results in over a million
hospitalizations in the United States annually and COPD is the third leading cause of 30-day
re-hospitalizations. Clinical trials have established the efficacy of treatments primarily
dispensed via respiratory inhaler devices that reduce morbidity and health care utilization
if they are used correctly. The effectiveness of these medications in real-world settings is
limited by the fact that patients often do not use inhalers correctly. Current guidelines
recommend assessing and teaching inhaler technique at all health care encounters, including
hospitalization. Over 75% of hospitalized patients in an urban, predominantly underserved
population misused their respiratory inhalers, highlighting a missed opportunity to educate
these patients with high potential to benefit. Hospitalization, therefore, provides a
potential 'teachable moment' to correct this misuse. My preliminary data indicate that one
strategy, in-person teach-to-goal (TTG), is effective in teaching hospitalized patients
proper inhaler technique and is more effective than simple verbal instruction. While TTG is a
promising, several limitations prevent widespread adoption. TTG is time-consuming and costly.
Also, reinforcement may be needed, which may be impractical with in-person TTG. One potential
method to surmount TTG's limitations is use of interactive video module education (VME) that
has the potential to be less costly, maintain fidelity, and be more easily extended into the
post-discharge setting than in-person TTG. Before widespread implementation of VME, it is
critical to rigorously develop and test VME for inhaler education in the hospital setting.
Ultimately, it will also be important to understand patients' ability and willingness to use
post-discharge VME for educational reinforcement to allow for this strategy to transition
patients across care settings from hospital to home.
We hypothesize that interactive VME will lead to non-inferior rates of ability to demonstrate
correct inhaler use compared to rates with TTG among hospitalized patients with Asthma or
COPD.
For this study we are testing the preliminary efficacy of VME to teach respiratory inhaler
technique prior to implementing a larger RCT to test the comparative effectiveness of VME
versus TTG.
The specific aim to test this hypothesis is:
To iteratively test VME to teach correct use of metered dose inhaler (MDIs) and dry-powder
Diskus® devices to hospitalized patients with Asthma or COPD. We partnered with software
development companies to develop VME modules that (self)-assess and teach respiratory inhaler
technique to hospitalized participants. We have tested the VME in focus groups. Now that the
VME is developed we will iteratively pilot test (n=30-40) the VME strategy (up to 3 rounds
(90-120 total)) to obtain important patient feedback,preferences and preliminary efficacy
estimates for the module.
We hypothesize that participants' post-VME inhaler technique will be significantly better
than their pre-VME inhaler technique.
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