By Barbara L. Massoudi, Project Director and Murrey G. Olmsted, Senior Advisor, BreathEasy, RTI International
For patients using our smartphone application for collecting and tracking ODLs, lately the team has been wrestling with the question of how long to run the intervention. Given that asthma is a chronic condition with intermittent, and often unpredictable acute exacerbations, we would need to collect the ODLs for a sufficiently long time to increase the likelihood that we’d capture data during at least one acute exacerbation period, but not so long that the patients would tire of using the application.
It seemed to us that there would be some ideal length of time that would balance both of these considerations, while giving us adequate time to allow for iterative improvements to the application based on patient and clinician feedback. The question of how long to run the intervention is made more complicated by the fact that typically, behavioral interventions are supported by regular interactions with clinicians over time, and that there is a process to incorporate the intervention into the patients’ lifestyle and the clinical practice.
We consulted with Project HealthDesign National Advisory Committee member, David Ahern, Ph.D., to get his recommendations on this question. After an interesting discussion with David, we concluded that the best approach would be to conduct two short intervention periods of two to four weeks each, and then run the final, full trial for three months.
During week one, David predicted, patients and clinicians would be getting used to the tool. The following two to four weeks would provide enough time then to get good compliance with ODL tracking. Following this four week intervention period, we’d collect feedback from patients and clinicians, adapt the system and then run another short intervention. We’d again make improvements to the tools and then begin the full evaluation trial for a three month period, giving us enough time to gather ODLs when patients were likely to have at least one acute exacerbation.
This timeframe for the evaluation discussed feels right to the team. We never expected that we’d create a tool that patients would necessarily have to use forever. The key to ultimately answering this question will be fine-tuning the intervention period to determine just how long patients and clinicians will need to use the tools to see the benefit. To answer that question definitively, we’d need to do a follow-up study looking at differing lengths of interventions and their relative effectiveness in achieving the intended outcomes. For now, we’ll focus on getting the tool right and achieving patient and clinician compliance for our limited evaluation phase.
To those who have had similar scenarios with patients, have you ever encountered an issue quite like this? If so, how did you test it out to find what works best for patients?