Page 106 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Chapter 6
Preferably, telemanagement is integrated into an electronic medical registry that is used by the health care provider and a personal electronic health record used by the patient. Finally, telemanagement could include educational modules, i.e. interactive information on inhalation technique and a module for electronic consultations.
There are a number of ethical issues to consider in telemanagement related to the empowerment of the patient: privacy of information, informed consent, the accessibility and usability of the technology, and the danger of making patients too dependent on technological support instead of making them more autonomous.
However, in our view telemanagement might help to shape patient autonomy based on considerations of relationality, care and responsibility which may better serve patients [22].
Effectiveness of telemanagement in asthma
A recent meta-analysis conducted by McLean et al. included 21 randomized controlled clinical trials on telehealthcare interventions in both children and adults with asthma [23]. These studies embodied a broad range of different interventions varying from follow-up of medication adherence by telephone to internet-based self-monitoring and feedback. The authors conclude that telehealthcare was not associated with a clinical relevant improvement in asthma related quality of life or risk of visits to the emergency department. However, in this meta-analysis there were only few examples of a comprehensive telemanagement approach in asthma.
Furthermore, patients in the control strategies often received an enhanced form of usual care, which makes it difficult to draw final conclusions on the effectiveness of telemanagement in asthma. In the study by Van der Meer et al. [24] in patients with mild to moderate persistent asthma it was demonstrated that a comprehensive telemanagement approach consisting of a treatment plan, self-monitoring of lung function by FEV1 and asthma control with feedback, and e-communication with a professional to support the patients’ self-management can lead to significant improvements in quality
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