Effects of an asthma mHealth system on health services use: A pragmatic trial

Background:Breathe is a mobile health (mHealth) application used for asthma self-management; however, its effects on the use of health care services remain poorly understood. Aim: To determine whether breathe reduces health service use in asthma patients who use the app compared to internal and external controls who do not. Methods: We conducted a pragmatic trial using data from the province of Ontario, Canada. Two groups of subjects who had participated in a randomized clinical trial (RCT) were included: an intervention group of adult asthma patients who used breathe for 12 months, and a control group of patients who did not use the app but received equivalent asthma care. A third, external control group of asthma patients were identified from an existing population cohort and matched to intervention subjects using a propensity-score approach. Generalized linear mixed models were used to determine changes in asthma-related hospitalizations, emergency department (ED) visits and outpatient physician visits over time. Results: A total of 641 individuals with asthma were included in the study. There were no statistically significant differences in the change of asthma-related hospitalization or ED visits between the intervention group and either the internal or external control group. However, compared to the external controls, the intervention group had a significantly greater decrease in the rate of physician office visits for asthma during the study (-10.8 per 100 vs. -4.3 per 100; p=0.018) and 1-year post (-19 per 100 vs. -8 per 100; p=0.032) compared to 1-year prior to the study. Conclusions: Use of breathe is associated with a significant decrease in the rate of physician office visits for asthma.