MP3 players lend an ear to asthma patients

MP3 players are generally associated with entertainment, but a hospital in Singapore is tapping on this multimedia gadget to help asthma patients better manage their condition.

Good asthma control not only requires appropriate medical treatment, it should also be supported by a patient-education system designed to effectively improve the patient's self-management skills and facilitate behavioral change.

Singapore's largest healthcare group SingHealth, last year ran its Telecare for Asthma pilot to evaluate how technology could be used to provide personalized asthma education. The SingHealth group consists of nine polyclinics, five national specialty centers and three hospitals, including Singapore General Hospital (SGH).

Launched in May last year to coincide with the World Asthma Day, the six-month pilot was conducted in collaboration with the SGH's Department of Respiratory and Critical Care Medicine and Department of Pharmacy.

Trials were carried out on two main patient groups: asthma patients with low literacy, and asthmatics "on the move".

Due to their low literacy, the first group of patients were unable to comprehend written asthma action plans and were chosen from among high-risk asthmatics attending the hospital's asthma clinic. In total, seven patients in this group participated in the pilot over an average 56 days.

High-risk asthmatics were defined as patients who were clinically diagnosed with asthma, had at least one hospital admission for exacerbation of the illness in the preceding 12 months, or had at least one severe exacerbation of asthma in the previous six months requiring an unscheduled visit for "beta2-agonist nebulization", a therapy to relieve airway obstruction.

In the Telecare trial, asthma educators downloaded audio action plans, personalized for each subject in the patient's spoken language, into an MP3 player. The players were distributed on loan to the patients who were also taught how to use the gadgets.

On average, the trial users listened to the recordings 10 times.

According to SingHealth, feedback from the patients was encouraging, with only one providing negative feedback.

The other six participants noted that the recordings improved their knowledge and skills in managing their illness. They added that the project also increased their self-confidence to self-manage their condition, improved their asthma care and enhanced their quality of life.

In fact, according to SingHealth, one patient who had an asthma exacerbation during the trial period, referred to the audio recording and was able to recover without needing specialized medical attention. In an asthma exacerbation, patients experience difficulty in breathing, as well as increasing wheezing and coughing.

Six of the pilot participants found the MP3 player easy to use and convenient, and would recommend the audio asthma action plan to other asthma sufferers.

One participant said he did not know how to operate the player, despite being given instructions on its use and having been provided a repeat demonstration.

Asthma educators involved in the trial said the project improved the patients' ability to self-manage their condition, reduced clinic-counseling time, and fitted well into their workflow in providing healthcare services.

Despite the positive response, SingHealth said: "Further studies are needed to confirm that the audio asthma action plan may overcome the illiteracy barrier and effect a behavioral change".

Healthcare on the go
The second group of participants in the Telecare pilot involved asthma patients while they were "on the move". These participants received personalized asthma action plans via SMS (short messaging service), or Adobe Systems' PDF document format from SingHealth's MyTeleCare HealthGuard portal.

As the doctors at SGH recognize that some asthma patients do not carry their written action plans with them, while others tend to misplace theirs, the medical professionals suggested a way to tap the high usage of mobile devices such as handphones, PDAs and MP3 players in Singapore.

These patients can then refer to their asthma action plan at their convenience.

They can also view or download, from the MyTeleCare portal to their PCs or mobile devices, personalized asthma education video clips demonstrating the correct technique of using their inhaler--a device typically used by asthma sufferers to administer medicine directly into the bronchial passageways, via the mouth, to facilitate clearer breathing.

According to SingHealth, the trial project helped supplement and reinforce asthma education and counseling during clinic sessions.

Alvin Sim, 51, is one of the patients who took part in this pilot.

"The videos show the proper procedures of controlling asthma, and they are very detailed and user-friendly," Sim told ZDNet Asia in an e-mail interview. "It's also convenient because you can view it as and when you want to."

Dr. Tan Keng Leong, senior consultant at the SGH's Department of Respiratory and Critical Care Medicine explained in an e-mail interview: "These projects, using innovative technology, helped us to reach out to different subsets of asthmatics, with a view to overcoming the illiteracy barrier and barriers to good asthma education and asthma care."

An SGH spokesperson said in an e-mail interview that the hospital was encouraged that the pilots were well-received by both patients and asthma educators,

"In future phases, these favorable results will set the stage for a larger scale implementation of the systems in SGH, and other SingHealth hospitals and polyclinics, if funding and support for post-trial costs are available."

She added: "While we envisage that these projects will improve asthma care and asthma outcomes, further studies are needed to confirm that these innovative projects may lead to improved asthma outcomes."