Effectiveness and acceptability of asynchronous digital health in asthma care: a mixed-methods systematic review (ID 548)
The University of Edinburgh
Abstract
Aim: To systematically review the quantitative and qualitative evidence to derive recommendations for policy and practice on the use of asynchronous digital health for asthma care.
Methods: We searched six databases (January 2001 – July 2022; search update: September 2023). Screening and data extraction were duplicated. Analysis: meta-analysis (trial data), thematic analysis (qualitative data) and narrative synthesis (others). Methodological quality: Revised Cochrane risk of bias tool (RCTs), Downs and Black checklist (other quantitative studies), Critical Appraisal Skills Programme (qualitative studies) and Mixed Methods Appraisal Tool (mixed-methods studies). Confidence in evidence: GRADE (quantitative) and GRADE-CERQual (qualitative).
Results: We included 30 studies (20 quantitative, 6 qualitative, 4 mixed-methods). Asynchronous digital consultations linked with other functionalities, compared to usual care, improved asthma control (SMD 0.32; 95% CI 0.02 to 0.62; P=.04) and reduced hospitalisations (RR 0.36; 95% CI 0.14 to 0.94; P=.04). However, there were no significant differences in quality of life (SMD 0.16; 95% CI -0.12 to 0.43; P=.26). or emergency department visits (RR 0.83; 95% CI 0.33 to 2.09; P=.69). Patients appreciated the convenience of asynchronous digital health, though healthcare professionals expressed concerns. Successful implementation necessitates an organisational approach. Integrative synthesis underscored the ease of asking questions, monitoring logs, and medication reminders as key digital functionalities. The overall certainty of evidence for the clinical outcomes were judged as very low for asthma control; and low for quality of life, emergency department visit and hospitalisation. Qualitative findings varied in confidence from low to high.
Conclusion: Asynchronous consultation supported by digital functionalities is an effective and convenient option for non-emergency asthma care, showing good acceptability among individuals with asthma and their caregivers. Thus, asynchronous digital consultations present an opportunity for those whose lifestyles or geographical locations impede synchronous consultations, but require organisation strategies to manage workload.
Funding: NU is supported by a University of Edinburgh College of Medicine PhD Studentship within the Asthma UK Centre for Applied Research (AUKCAR), and JS is supported by National Institute for Health Research Applied Research Collaboration (ARC) North Thames.
Conflicts of interest: None.
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