Page 151 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Discussion
Principal results
This study shows that adherence is an important modifier of the benefits of internet based monitoring systems in patients with severe asthma. Better adherence to the internet system in these patients was associated with better health outcome, which was the reduction of the daily dose of prednisone. In addition, better adherence was significantly associated with lower medical costs. This indicates that internet applications are effective and cost-saving options in patients with severe asthma, and that good adherence to the internet system is required for optimal outcome.
Comparison with prior publications
To our knowledge this is the only study evaluating the effect of adherence to an internet-based management strategy on clinical outcomes and health care use. Previous studies reported that most internet-based interventions are only used by a very specific group of users (eg. young people, women, highly educated) [31] and that even after improvement of health outcomes it is very difficult to keep them engaged [31]. A systematic review pointed out that roughly 50% of the participants of web-based interventions adhere fully to the system [32] and in a randomised controlled trial with patients with mild asthma the actual use of the online application was also low [8]. In the present study the participant patients had stable high levels of adherence to the internet- based tool during 6 months with a subsequent improvement in health related outcomes. This demonstrates not only that older patients with a severe disease are ready for the implementation of this innovative tool in the management of their complex disease but also their level of self-motivation and recognition of the benefits to their health.
Limitations
A few caveats should be taken into account when interpreting our results. The cost estimates were based on the quarterly questionnaire filled in by the patients and were therefore subjected to the patient’s recall bias. In addition, despite assessing direct costs related to asthma and co-morbidities and the relationship with the level of adherence to the internet system, this was not mean to be a cost-effectiveness study. We also did not evaluate
Adherence to telemanagement
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