Improving Parental Adherence with Asthma Treatment Guidelines: A Randomized Controlled Trial of an Interactive Website

BACKGROUND: Controllers are underprescribed for children with asthma, and when they are, adherence is suboptimal. We sought to test whether an interactive website grounded in social cognitive theory can improve the dispensing of controller medications and adherence with them where indicated. METHODS: Randomized controlled trial. Parents of eligible patients were randomized to be prompted to assess their child's asthma each month for 6 months and receive tailored feedback on controller use and adherence strategies. For the next 6 months, participation in the site was optional. Outcomes were assessed at 6 and 12 months. RESULTS: A total of 603 families were enrolled. At baseline, 176 (29%) children had mild-to-severe persistent asthma, whereas 71% of children met criteria for mild intermittent asthma. Among patients who should have been on controllers at baseline but were not, there was no statistically significant increase in controller prescriptions at 6 months (odds ratio [OR] 2.85; 95% confidence interval [95% CI] 0.63-14.04], P = .17). There was a trend to improved adherence with controllers among users at 6 months (OR 1.54, 95% CI 0.90-2.63, P = .10). Among patients who used controller medicine at both baseline and at 6 months, users in the intervention arm had significantly greater adherence than those in control arm at 6 months (OR 1.92; 95% CI 1.05-3.55; P = .02). For patients with persistent asthma at baseline and who were on controller medicine at both time points, patients in the intervention arm had significantly better adherence than those in the control arm at 6 months (OR 3.33; 95% CI 1.20-10.07, P = .01). However, there were no discernible differences at the 12-month assessment. CONCLUSION: A tailored interactive website shows some benefit in improving controller medication adherence during a period of active intervention.