Abstract

Background and Aim
Traditional care pathways are often inefficient, leading to unnecessary appointments and suboptimal disease control due to the variability of the disease and low medication compliance. Digital health interventions offer promising improvements by using technology for remote monitoring, data-driven treatment, and self-monitoring. This paper details a multi-centre, three-month service evaluation of a "Smart Asthma Virtual Monitoring" aimed at improving respiratory care by enhancing healthcare efficiency and patient adherence.

Methods
This multi-centre, three-month service evaluation involved 667 patients with respiratory conditions, primarily asthma, across 26 NHS and HSE Ireland centres. The "Smart Asthma Virtual Monitoring" is a digital health platform featuring cost-effective sensors, a patient app, and a clinician dashboard. Data collection included an Active Inhaler Monitoring Service for 299 patients to track inhaler use and an Active Respiratory Monitoring Service for 368 patients to record peak expiratory flow (PEF), symptoms, and reliever inhaler use (both SABA and reliever doses of MART). Data on patient adoption, recording frequency, clinician feedback, and system-level impacts were collected and analysed using descriptive statistics and qualitative analysis.

Results
The evaluation showed a 66% adoption rate among recruited families, with patients recording an average of seven data points per week. Patients found the digital recording convenient and valued the ability to share data and receive notifications. Clinicians reported that the intervention empowered patients, provided more reliable data than mechanical meters, and increased their confidence in clinical decisions. They also reported a significant improvement in clinically useful PEF charts (50% with Smart Asthma vs. 10% with mechanical meters), and 100% of clinicians expressed a desire to continue using the system. Potential system-level impacts assessed by participating clinicians included the support for reduced unnecessary visits, prevented referrals, decreased emergency department (ED) re-attendances, and optimisation of medication use by identifying poor adherence.

Conclusions
Digital health improves respiratory care efficiency and effectiveness. This intervention enhanced patient engagement, medication adherence, and reduced unnecessary healthcare utilisation. Technology is crucial for patient self-management, medication optimisation, and streamlined healthcare, leading to better outcomes and resource allocation. Long-term impacts and broader applicability require further research.