Evaluating the effect of a digital health app for self-management and telehealth support for high-risk asthma patients on the frequency of hospital visits

Intervention Physical and Informational Materials The intervention involves the implementation of a digitally enabled asthma care model for children and adults with severe asthma. Each participant is provided with a home monitoring kit containing a peak flow meter, a spacer, and a mask, which are delivered either during hospital admission, by courier, or by an AITN team member. Participants are also encouraged to purchase their own pulse oximeter for home use. Access to the CareMonitor platform requires an internet-connected device such as a smartphone, tablet, or computer. Participants can access the platform from home or any location with internet access, including community settings such as libraries, to enter symptom data, receive alerts, and access educational content. Educational resources from Asthma Australia provided through the platform include guidance on inhaler technique, asthma self-management strategies, and information about the asthma action plan used to categorise symptom severity. Each participant’s asthma action plan is developed or reviewed by a junior doctor and respiratory physician or paediatrician, and then transcribed into the digital platform by a respiratory nurse. CareMonitor is a secure, cloud-based digital health platform used to support remote patient monitoring, care coordination, and symptom tracking. It is integrated into the Northern Adelaide Local Health Network’s virtual care infrastructure (VIVA platform) and accessible via smartphone, tablet, or web browser. Procedures, Activities, and Support Processes Following enrolment and consent via REDCap, each participant attends a nurse-led onboarding session, which may be conducted in person at Lyell McEwin Hospital, Modbury Hospital, or via telehealth, depending on participant preference. During this session, the nurse collects baseline demographic and clinical data, administers validated questionnaires, and provides education on how to use the CareMonitor app and the home monitoring kit Participants are instructed to log their asthma symptoms into CareMonitor at least once per week or whenever their symptoms change. They select the level of their Asthma Action Plan that best reflects their current condition (well-controlled, flare-up, severe, or emergency). The app reinforces the participant’s Asthma Action Plan by providing tailored guidance on what actions to take, supporting self-management without requiring immediate clinician input. If a participant selects a level indicating worsening symptoms, a clinical alert is generated and reviewed by an AITN respiratory nurse within one business day. Alerts are reviewed by an AITN respiratory nurse within one business day. The nurse responds through a phone or video consultation to assess the participant’s clinical status, provide education, reinforce adherence to the asthma action plan, and, if required, escalate care. This may involve arranging a GP or respiratory physician consultation, referring to an urgent care centre, or activating emergency services. In addition to symptom monitoring, participants receive fortnightly asthma control questionnaires via the CareMonitor app. Responses are reviewed by the clinical team, with follow-up initiated if a participant reports symptom worsening or fails to respond. At the end of the six-month period, participants complete a final set of outcome questionnaires, and a summary of their involvement is sent to them or their parent/guardian. Intervention Providers and Expertise The intervention is delivered by a multidisciplinary team. The AITN respiratory nurses are trained in asthma education, digital platform use, and escalation protocols, and are responsible for onboarding, monitoring, and patient follow-up. Junior doctors and respiratory physicians or paediatricians oversee the development and review of each participant’s asthma action plan. Mode of Delivery Care is delivered through a hybrid model. Most interactions occur remotely, either through the CareMonitor app or via telehealth using phone or video calls. In-person interactions may occur when clinically indicated or when preferred by the participant, particularly during onboarding or action plan development. All care is delivered individually rather than in group sessions. Frequency and Duration The intervention is designed to run over a six-month period for each participant. At the start, participants complete a single onboarding session lasting between 30 and 60 minutes, which may be conducted either in person or via telehealth. They are expected to log their asthma symptoms into the CareMonitor platform at least once per week, or more frequently if symptoms change or worsen. Throughout the study period, participants continue engaging with the platform by completing fortnightly asthma control questionnaires and regularly updating their symptom data. In addition to these routine interactions, further follow-up may occur whenever clinically necessary. If a participant enters symptom data that indicates worsening asthma control (amber, red, or emergency zone), the system automatically generates an alert. These alerts are reviewed by an AITN respiratory nurse within one business day (Monday to Friday, 8:00 AM to 5:00 PM). The nurse then contacts the participant by phone or video call to assess their condition, provide clinical advice, reinforce asthma education, and escalate care if required. Similarly, if a participant does not log any data for more than ten days, the clinical team will reach out to re-establish contact and ensure the participant's well-being. Location of Delivery The intervention is primarily delivered in the participant’s home through digital technology and telehealth. In-person visits occur at NALHN-affiliated health sites, including Lyell McEwin Hospital, Modbury Hospital, and the Women’s and Children’s Hospital, depending on the participant’s clinical needs and preferences.