Open Access Open Badges Study protocol

e-Monitoring of Asthma Therapy to Improve Compliance in children using a real-time medication monitoring system (RTMM): the e-MATIC study protocol

Erwin C Vasbinder12, Hettie M Janssens3, Maureen P M H Rutten-van Mölken4, Liset van Dijk5, Brenda C M de Winter1, Ruben C A de Groot3, Arnold G Vulto1, Patricia M L A van den Bemt1* and e-MATIC Study Group

Author Affiliations

1 Department of Hospital Pharmacy, Erasmus Medical Center, Nc-212, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands

2 Department of Hospital Pharmacy, Groene Hart Ziekenhuis, B1.43, Bleulandweg 10, Gouda, HH 2803, The Netherlands

3 Department of Paediatrics, div. Paediatric Respiratory Medicine, Erasmus Medical Center/Sophia Childrens Hospital, Room Sp3456, P.O. Box 2060, Rotterdam, CB 3000, The Netherlands

4 lnstitute for Medical Technology Assessment / Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, DR 3000, The Netherlands

5 NIVEL, P.O. Box 1568, Utrecht, BN 3500, The Netherlands

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BMC Medical Informatics and Decision Making 2013, 13:38  doi:10.1186/1472-6947-13-38

Published: 21 March 2013



Many children with asthma do not have sufficient asthma control, which leads to increased healthcare costs and productivity loss of parents. One of the causative factors are adherence problems. Effective interventions improving medication adherence may therefore improve asthma control and reduce costs. A promising solution is sending real time text-messages via the mobile phone network, when a medicine is about to be forgotten. As the effect of real time text-messages in children with asthma is unknown, the primary aim of this study is to determine the effect of a Real Time Medication Monitoring system (RTMM) with text-messages on adherence to inhaled corticosteroids (ICS). The secondary objective is to study the effects of RTMM on asthma control, quality of life and cost-effectiveness of treatment.


A multicenter, randomized controlled trial involving 220 children (4–11 years) using ICS for asthma. All children receive an RTMM-device for one year, which registers time and date of ICS doses. Children in the intervention group also receive tailored text-messages, sent only when a dose is at risk of omission. Primary outcome measure is the proportion of ICS dosages taken within the individually predefined time-interval. Secondary outcome measures include asthma control (monthly Asthma Control Tests), asthma exacerbations, healthcare use (collected from hospital records, patient reports and pharmacy record data), and disease-specific quality of life (PAQLQ questionnaire). Parental and children’s acceptance of RTMM is evaluated with online focus groups and patient questionnaires. An economic evaluation is performed adopting a societal perspective, including relevant healthcare costs and parental productivity loss. Furthermore, a decision-analytic model is developed in which different levels of adherence are associated with clinical and financial outcomes. Also, sensitivity analyses are carried out on different price levels for RTMM.


If RTMM with tailored text-message reminders proves to be effective, this technique can be used in daily practice, which would support children with suboptimal adherence in their asthma (self)management and in achieving better asthma control and better quality of life.

Trial registration

Netherlands Trial Register NTR2583.

Real-time medication monitoring; Text-message reminders; Medication adherence; Inhaled corticosteroids; Children; Asthma