Improving Metered Dose Inhaler (MDI) Technique via a Modern Technology Platform

The overarching goal of this DNP project was to improve metered dose inhaler (MDI) technique by developing an innovative method via telemedicine for providing MDI technique education. MDIs are one of the most commonly used methods for delivery of asthma medication, and yet an astounding percentage of people with asthma do not use their MDI correctly. Depending on the study, between 14% to 90% of people who are prescribed MDIs use them incorrectly. The first objective was to develop standardized instructions utilizing manufacturer's recommendations to teach correct inhaler use to patients with asthma. The second objective was to utilize telemedicine to teach and reinforce correct inhaler use. The third objective was to evaluate effectiveness and patient satisfaction with use of telemedicine to teach and reinforce correct inhaler use. The telemedicine platform provided audio and video capabilities in order to speak with and see the participants live. Implementation of these objectives started by identifying the best methods for providing MDI technique, current MDI instructions, and a secure telemedicine platform. After submitting an Institutional Review Board (IRB) application, MDI technique assessment and education were carried out via telemedicine with adults diagnosed with asthma. Successful technique was measured by the assessment, and satisfaction of the delivery method was measured by an approved, short satisfaction survey given to the participants. Dissemination of the findings was presented through an abstract submitted at an approved conference. Telemedicine has roots as far as the 1920's, but it was not until the internet was created that real time face-to-face capabilities were made practical. The face-to-face component of the patient-provider experience has been shown to be one of the most valuable factors with medication compliance and adherence to instructions. However, most follow-up visits in clinic do not occur for at least three to six months, and sometimes not even then. With the lack of regular provider contact, adherence to instructions decreases. Decreased adherence to provider instructions on inhaler technique lead to poorer control of asthma, whereas better control of asthma has been related to better adherence of inhaler technique. With poorer control there is related healthcare costs, which continue to climb, and 1.8 million ED visits in 2011 due to asthma. While there is no cure for asthma, there are modifiable factors, which can improve asthma outcomes. Improving MDI technique is a modifiable factor, which is addressed by the implementation of telemedicine in this project. The final outcome of this project provided measurable results, and a positive experience with telemedicine. In conclusion, the initial telemedicine visits with the participants revealed that four out of ten were using their MDI incorrectly. After providing education, and after completing the second telemedicine visit, all ten participants were using their MDI correctly. Using telemedicine to provide MDI technique education showed positive results. The satisfaction survey also indicated positive results with responses indicating a positive experience using telemedicine. This type of experience could motivate patients to use telemedicine more often in the future.