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Cited by 13Telemedicine and Telehealth ImplementationAsthma and respiratory diseasesMobile Health and mHealth Applications

Effectiveness and Acceptability of Asynchronous Digital Health in Asthma Care: Mixed Methods Systematic Review

Open access
Uzzaman, Nazim, Hammersley, Victoria, McClatchey, Kirstie, Sheringham, Jessica, Singh, Diksha, Habib, GM Monsur, Pinnock, Hilary·2024·Journal of Medical Internet Research
DOI 10.2196/57708PMC PMC11653041

Published version of a preprint

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Abstract

Background: Asynchronous digital health (eg, web-based portal, text, and email communication) can overcome practical barriers associated with in-person and remote synchronous (real-time) consultations. However, little is known about the effectiveness and acceptability of asynchronous digital health to support care for individuals with asthma (eg, asthma reviews). Objective: We aimed to systematically review the qualitative and quantitative evidence on the role of asynchronous digital health for asthma care. Methods: Following Cochrane methodology, we searched 6 databases (January 2001-July 2022; search update: September 2023) for quantitative, qualitative, or mixed methods studies supporting asthma care using asynchronous digital health. Screening and data extraction were duplicated. We assessed the risk of bias in the clinical outcomes of randomized controlled trials included in the meta-analysis using the revised Cochrane risk of bias tool. For the remaining studies, we evaluated the methodological quality using the Downs and Black checklist, critical appraisal skills program, and mixed methods appraisal tool for quantitative, qualitative, and mixed methods studies, respectively. We determined the confidence in the evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) criteria. We conducted a meta-analysis of trial data and a thematic analysis of qualitative data. Results: We included 30 studies (20 quantitative, 6 qualitative, and 4 mixed methods) conducted in 9 countries involving individuals with asthma, their caregivers, and health care professionals. Asynchronous digital consultations linked with other functionalities, compared to usual care, improved asthma control (standardized mean difference 0.32, 95% CI 0.02-0.63; P=.04) and reduced hospitalizations (risk ratio 0.36; 95% CI 0.14-0.94; P=.04). However, there were no significant differences in quality of life (standardized mean difference 0.16; 95% CI –0.12 to 0.43; P=.26) or emergency department visits (risk ratio 0.83; 95% CI 0.33-2.09; P=.69). Patients appreciated the convenience of asynchronous digital health, though health care professionals expressed concerns. Successful implementation necessitated an organizational approach. Integrative synthesis underscored the ease of asking questions, monitoring logs, and medication reminders as key digital functionalities. Conclusions: Despite low confidence in evidence, asynchronous consultation supported by digital functionalities is an effective and convenient option for nonemergency asthma care. This type of consultation, well accepted by individuals with asthma and their caregivers, offers opportunities for those facing challenges with traditional synchronous consultations due to lifestyle or geographic constraints. However, efficient organizational strategies are needed to manage the associated workload. Trial Registration: PROSPERO CRD42022344224; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=344224 International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0281538

AI snapshot

Written from the paper’s full text.

TL;DR

This mixed methods systematic review found that asynchronous digital consultations supported by other digital functionalities improved asthma control and reduced hospitalizations compared with usual care, but not quality of life or emergency department visits. Patients and caregivers generally accepted asynchronous digital health, while health care professionals raised clinical and implementation concerns, and confidence in the clinical evidence was low to very low.

Key findings

  • Across 30 included studies (20 quantitative, 6 qualitative, 4 mixed methods) from 9 countries, asynchronous digital consultations linked with other functionalities versus usual care improved asthma control (SMD 0.32, 95% CI 0.02-0.63; P=.04) and reduced hospitalizations (RR 0.36, 95% CI 0.14-0.94; P=.04).
  • No significant differences were found for quality of life (SMD 0.16, 95% CI –0.12 to 0.43; P=.26) or emergency department visits (RR 0.83, 95% CI 0.33-2.09; P=.69).
  • Sensitivity analyses weakened some findings: asthma control remained significant after exclusions (SMD 0.20, 95% CI 0.03-0.37; P=.02) but became non-significant when including a study reporting undifferentiated ACT and C-ACT scores (SMD 0.14, 95% CI –0.01 to 0.29; P=.06); hospitalization became inconclusive (RR 0.52, 95% CI 0.11-2.42; P=.40).
  • Qualitative synthesis found patients appreciated convenience, while health care professionals expressed concerns; implementation barriers included lack of EHR integration, poorly coordinated workflow, high workload, and no financial reimbursement, while facilitators included easy 2-way communication, prompt responsiveness, and efficient task allocation. GRADE certainty was very low for asthma control and low for quality of life, emergency department visits, and hospitalization.

Methods

  • Mixed methods systematic review following a results-based convergent design, Cochrane methodology, and PRISMA; searched 6 databases from January 2001 to July 2022, with an update in September 2023, yielding 11,034 records, 5662 screened titles/abstracts, 85 full texts assessed, and 30 studies included.
  • Quantitative RCT data were pooled in meta-analysis using RevMan; SMD with 95% CI via inverse variance for asthma control and quality of life, and RR with 95% CI via Mantel-Haenszel for emergency department visits and hospitalizations, using random-effects models.
  • Qualitative data were analyzed by thematic synthesis, quantitative and qualitative findings were integrated in a matrix, and quality/confidence were assessed with RoB 2, Downs and Black, CASP, MMAT, GRADE, and GRADE-CERQual.

Limitations

  • The paper states that GRADE confidence was low to very low for clinical outcomes, influenced by risk of bias, imprecision, self-reported outcome measures, and diverse tools for asthma control and quality of life; heterogeneity was a concern, and fewer than 10 studies precluded funnel plot assessment.
  • The paper states that no included studies reported asynchronous digital consultations as an isolated intervention, so effectiveness was assessed only for asynchronous consultations supported by other digital health functionalities.
  • Evident from the text: the search update found no eligible new studies; most qualitative studies (5/6) and mixed methods studies (3/4) raised some methodological concerns, and several non-meta-analyzed quantitative studies had poor Downs and Black scores; no studies explicitly addressed non-digital support for using digital functionalities.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/57708

Cites

80 of 80 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 50 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Online chat was used in 12 of the studies documenting digital functionalities.

    “online chat (n=12) [50,53,54,57,59,60,65,72-74,76,79]”
    Quote in the paperNot a substantial claim
  • Findingcitation

    The response time for asynchronous communication ranged from within 24 hours to 48 hours and 72 hours.

    “The response time ranged from within 24 hours [51,54] to 48 hours [61,72] and 72 hours [78].”
    Quote in the paperNot a substantial claim
  • Findingown data

    In total, 21 studies documented the use of digital functionalities for asynchronous communication between patients or their caregivers and health care professionals.

    “In total, 21 studies documented the use of digital functionalities”
    Quote in the paperNot a substantial claim
  • Findingnone given

    There was no specific pattern to differentiate the trials that reported increased risk of hospitalization compared with those that reported reduced risk of hospitalization.

    “There was no specific pattern to differentiate the trials that reported increased risk of hospitalization [55] compared with those that reported reduced risk of hospitalization [60,67,72].”
    Quote in the paperNot a substantial claim
  • Findingcitation

    None of the patients or caregivers wanted to completely replace traditional face-to-face consultations with asynchronous digital health.

    “however, none wanted to completely replace traditional face-to-face consultations [66].”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 38
  • May combine two claims. 29

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Some participants highlighted that too frequent messaging was counterproductive.

    “Some participants highlighted that too frequent messaging was counterproductive [58].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Major barriers to implementing asynchronous digital health in routine practice, as perceived by most health care professionals, included lack of integration with electronic health records, poorly coordinated workflow, high workload, and absence of financial reimbursement.

    “The major barriers, as perceived by most health care professionals, included lack of integration with electronic health records (EHRs) so that data have to be transferred manually [59,71,77], poorly coordinated workflow [59,71,77], high workload [70,71,77], and the absence of financial reimbursement [59,70,77].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Most parents reported checking their emails frequently, but this ranged from once a week to several times a day.

    “Most parents reported checking their emails “frequently,” but this ranged from once a week to several times a day.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The review included 30 studies (20 quantitative, 6 qualitative, and 4 mixed methods) conducted in 9 countries involving individuals with asthma, their caregivers, and health care professionals.

    “We included 30 studies (20 quantitative, 6 qualitative, and 4 mixed methods) conducted in 9 countries involving individuals with asthma, their caregivers, and health care professionals.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Most patients or caregivers found asynchronous digital health feasible and accessible.

    “Most patients or caregivers found asynchronous digital health feasible and accessible [63,66,75]”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    SMS was used in 4 of the studies documenting digital functionalities.

    “SMS (n=4) [67,69,74,76]”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Email was used in 12 of the studies documenting digital functionalities.

    “email (n=12) [51,55,56,59-61,68,69,74,76,78,80]”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    The thematic synthesis yielded four themes: acceptability of routine asthma reviews, advantages and disadvantages of asynchronous digital health, implementation barriers and facilitators, and preferred digital functionalities.

    “The thematic synthesis yielded four themes: (1) acceptability of routine asthma reviews, (2) advantages and disadvantages of asynchronous digital health, (3) implementation barriers and facilitators, and (4) preferred digital functionalities.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Health care professionals noted clinical limitations of remote reviews.

    “noted the clinical limitations of remote reviews [63]”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingcitation

    Parents felt that asynchronous digital health improved day-to-day care management and reduced unplanned provider visits.

    “Parents felt that asynchronous digital health improved day-to-day care management and reduced unplanned provider visits.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Both health care professionals and parents of children with asthma recognized accessible easy 2-way communication, prompt responsiveness from practices and families, and a positive attitude and commitment towards adopting asynchronous digital health as facilitators.

    “Both health care professionals and parents of children with asthma recognized that accessible “easy” 2-way communication, prompt responsiveness from practices and families, as well as a positive attitude and commitment towards adopting asynchronous digital health were facilitators [52,59,71].”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Of the 2 of 5 RCTs that reported reduced risk of emergency department visits, 1 had medication reminders and the other was linked with the EHR.

    “Of 2 of the 5 RCTs [55,57,60,68,72] that reported reduced risk of emergency department visits, 1 had medication reminders [57], and the other was linked with the EHR [60].”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Health care professionals expressed concerns that the lack of physical examination and reduced face-to-face contact associated with asynchronous digital health could negatively affect clinical decision-making.

    “They also expressed concerns that the lack of physical examination and reduced face-to-face contact associated with this approach could negatively affect clinical decision-making [71].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    One RCT that reported no change in quality of life also had ease of asking quick questions, monitoring logs, tailored asthma information, and organized workflow.

    “One RCT that reported no change in quality of life also had these features [55].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Health care professionals viewed text messaging and emails as effective means to connect with patients, enhancing communication, and fostering compliance and treatment adherence.

    “Health care professionals viewed text messaging and emails as effective means to connect with patients, enhancing communication, and fostering compliance and treatment adherence [62,70].”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Most patients wanted the flexibility to ask quick questions, receive tailored information about asthma, log and visualize the trend of their peak flows, symptom scores, and medication usage, and receive medication reminders.

    “Most patients wanted the flexibility to ask quick questions [63], receive tailored information about asthma [63,66,71], log and visualize the trend of their peak flows, symptom scores, and medication usage [63], and receive medication reminders [52,58].”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Health care professionals perceived that asynchronous digital health was not suitable for patients with poor perception of their asthma symptoms or needing emergency care.

    “Health care professionals perceived that asynchronous digital health was not suitable for patients with poor perception of their asthma symptoms or needing emergency care [70].”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Among qualitative studies, 5 raised some concerns.

    “while 5 raised some concerns [52,58,66,70,71]”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [52] source

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    • cites [58] source

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    • cites [66] source

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    • cites [70] source

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    • cites [71] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The Downs and Black scores ranged from 6 to 24 for the other quantitative studies that were not included in the meta-analysis.

    “The Downs and Black scores ranged from 6 to 24 for the other quantitative studies that were not included in the meta-analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Health care professionals in our study believed asynchronous digital health could enhance communication and improve compliance and treatment adherence.

    “Health care professionals in our study believed asynchronous digital health could enhance communication and improve compliance and treatment adherence.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Methodological quality was fair in 2 studies (range: 15-19).

    “fair (range: 15-19) in 2 studies [69,76]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [69] source

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    • cites [76] source

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  • May combine two claims.

    Findingown data

    Health care professionals acknowledged convenience but noted that remote reviews might not always be clinically suitable.

    “Although they acknowledged convenience, they noted that remote reviews might not always be clinically suitable.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In our review, asynchronous digital health was favored by most parents of children with asthma and some adult patients, offering convenience for asthma management alongside work and family commitments.

    “In our review, asynchronous digital health was favored by most parents of children with asthma and some adult patients, offering convenience for asthma management alongside work and family commitments.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Patients valued remote monitoring, guidance from health care professionals, and self-management support.

    “They valued remote monitoring, guidance from health care professionals, and self-management support.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Among qualitative studies, 1 had high quality.

    “Among qualitative studies, 1 had high quality [77]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] source

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  • May combine two claims.

    Findingown data

    In our study, health care professionals perceived barriers to implementation, including workflow issues, lack of EHR integration, high workload, and absence of financial reimbursement.

    “In our study, health care professionals perceived barriers to implementation, including workflow issues, lack of EHR integration, high workload, and absence of financial reimbursement.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Confidence in the evidence was determined using the GRADE criteria.

    “We determined the confidence in the evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) criteria.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The review was registered at PROSPERO (CRD42022344224).

    “The review is registered at PROSPERO (CRD42022344224), and the protocol is published [26].”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Screening and data extraction were duplicated.

    “Screening and data extraction were duplicated.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    A random-effects model was used to account for heterogeneity in the study intervention, population, and settings.

    “We used a random-effects model to account for heterogeneity in the study intervention, population, and settings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The review adhered to Cochrane methodology and used PRISMA guidelines to report findings.

    “We adhered to Cochrane methodology [24] and used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to report our review findings [25].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Overall, ease of asking quick questions, medication reminders, tailored asthma information, and organized workflow emerged as important factors that might positively affect the intervention outcomes.

    “Overall, the ease of asking quick questions, medication reminders, tailored asthma information, and organized workflow emerged as important factors that might positively affect the intervention outcomes.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Risk of bias in the clinical outcomes of randomized controlled trials included in the meta-analysis was assessed using the revised Cochrane risk of bias tool.

    “We assessed the risk of bias in the clinical outcomes of randomized controlled trials included in the meta-analysis using the revised Cochrane risk of bias tool.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Methodological quality of the remaining quantitative, qualitative, and mixed methods studies was evaluated using the Downs and Black checklist, critical appraisal skills program, and mixed methods appraisal tool, respectively.

    “For the remaining studies, we evaluated the methodological quality using the Downs and Black checklist, critical appraisal skills program, and mixed methods appraisal tool for quantitative, qualitative, and mixed methods studies, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Despite low confidence in evidence, asynchronous consultation supported by digital functionalities is an effective and convenient option for nonemergency asthma care.

    “Despite low confidence in evidence, asynchronous consultation supported by digital functionalities is an effective and convenient option for nonemergency asthma care.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Challenges such as poor attendance at asthma clinics, time constraints, limited resources, and competing agendas during consultations hinder effective asthma reviews.

    “However, challenges such as poor attendance at asthma clinics, time constraints, limited resources, and competing agendas during consultations hinder effective reviews [5].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] source

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  • May combine two claims.

    Premisecitation

    Although asynchronous digital health can overcome time constraints linked to in-person and synchronous remote reviews and has the potential to support care of the large number of people with asthma, it remains underresearched.

    “Although asynchronous digital health can overcome the time constraints linked to in-person and synchronous remote reviews and has the potential to support care of the large number of people with asthma, it remains underresearched [14].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] source

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    Interpretationcitation

    This study extends the findings of a recent Cochrane review on digital interventions specifically for improving asthma treatment adherence.

    “This extends the findings of a recent Cochrane review on digital interventions specifically for improving asthma treatment adherence [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] source

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    Premisecitation

    This review observed a decline in visits among back pain and asthma patients, although these differences were not statistically significant.

    “However, this review did observe a decline in visits among back pain and asthma patients, although these differences were not statistically significant [83].”
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    • cites [83] source

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    Premisecitation

    A scoping review focused on a different health condition using asynchronous digital health demonstrated improved self-efficacy and quality of life.

    “In contrast, a scoping review focused on a different health condition using asynchronous digital health demonstrated improved self-efficacy and quality of life [82].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [82] source

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  • May combine two claims.

    Study design and conductreasoning

    The GRADE assessment reflected low to very low confidence in clinical outcomes, influenced by self-reported outcome measures and diverse tools for asthma control and quality of life.

    “While our GRADE assessment reflected low to very low confidence in clinical outcomes, this was influenced by self-reported outcome measures and diverse tools for asthma control and quality of life.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The review maintained openness to non-English papers in quantitative studies and included 1 in Russian.

    “We maintained an openness to non-English papers in quantitative studies and included 1 in Russian [54].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The review conducted a comprehensive database search, aided by a senior librarian.

    “We conducted a comprehensive database search, aided by a senior librarian, and the meta-analysis was reviewed by a senior statistician from the University of Edinburgh.”
    Quote in the paperNot a substantial claim

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    Study design and conductnone given

    A strength of this review is its inclusive design, encompassing various study types and integrating quantitative and qualitative findings.

    “A strength of this review is its inclusive design, encompassing various study types and integrating quantitative and qualitative findings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A study involving individuals with diabetes highlighted the benefits of asynchronous communication that complemented clinic visits and boosted patients' sense of responsibility for managing their conditions.

    “A study involving individuals with diabetes highlighted the benefits of asynchronous communication that complemented clinic visits and boosted patients' sense of responsibility for managing their conditions [85].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [85] Eschler, J, 2015, AMIA Annu Symp Proc

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  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Effective implementation of asynchronous digital health requires an organizational approach.

    “Effective implementation requires an organizational approach.”
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    Study design and conductcitation

    The review did not deviate from the methodology outlined in the published protocol.

    “We did not deviate from the methodology outlined in the published protocol [26].”
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    • cites [26] source

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  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductnone given

    The involvement of a multidisciplinary author group proficient in qualitative evidence synthesis helped ensure a balanced interpretation of the data.

    “Nonetheless, the involvement of a multidisciplinary author group proficient in qualitative evidence synthesis helped ensure a balanced interpretation of the data.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    A systematic review indicated that health care utilization, specifically physician visits, did not decrease significantly.

    “Similarly, we found no significant change in emergency department visits, consistent with a systematic review indicating that health care utilization, specifically physician visits, did not decrease significantly.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [83] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Data extraction and analysis were duplicated (NU and MH/DS), and the precision of the data was verified by another author (HP).

    “While data extraction and analysis were duplicated (NU and MH/DS), the precision of the data was verified by another author (HP).”
    Quote in the paperNot a substantial claim

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    Study design and conductnone given

    The meta-analysis was reviewed by a senior statistician from the University of Edinburgh.

    “We conducted a comprehensive database search, aided by a senior librarian, and the meta-analysis was reviewed by a senior statistician from the University of Edinburgh.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Two independent reviewers screened titles, abstracts, and full texts, resolving discrepancies through discussion with other authors as needed.

    “In total, 2 independent reviewers screened titles, abstracts, and full texts, resolving discrepancies through discussion with other authors as needed.”
    Quote in the paperNot a substantial claim

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    Interpretationcitation

    The incongruity could be linked to the study's combined reporting of ACT and C-ACT measures despite the known differences in their performance.

    “This incongruity could be linked to the study's combined reporting of ACT and C-ACT measures despite the known differences in their performance [78].”
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    • cites [78] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Asynchronous digital health could be especially valuable for patients and health care professionals with existing familiarity with digital technologies.

    “This could be especially valuable for patients and health care professionals with existing familiarity with digital technologies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Our review concludes with low confidence that asynchronous consultation supported by digital functionalities is effective and convenient.

    “Our review concludes with low confidence that asynchronous consultation supported by digital functionalities is effective and convenient and can be considered as an option for non-emergency asthma care, showing good acceptability among individuals with asthma and their caregivers.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Asynchronous digital consultations present an opportunity for those whose lifestyles or geographical locations impede synchronous consultations but require organization strategies to manage workload.

    “Thus, asynchronous digital consultations present an opportunity for those whose lifestyles or geographical locations impede synchronous consultations but require organization strategies to manage workload.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Efficient task allocation and organization of care are crucial implementation facilitators.

    “Efficient task allocation and organization of care are crucial implementation facilitators.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A systematic review reported that several publications, mostly on the use of telehealth in dermatology and some that assessed multiple medical specialties, reported a positive impact on process of care outcomes, including shorter wait times and less time to perform a consultation.

    “A systematic review reported that several publications, mostly on the use of telehealth in dermatology and some that assessed multiple medical specialties, reported a positive impact on process of care outcomes, including shorter wait times and less time to perform a consultation [84].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Deshpande, A, 2009, Open Med

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    Premisecitation

    Some health care systems have introduced guidelines, such as requiring at least 1 in-person visit before an e-visit, to establish patient-clinician relationships.

    “Some health care systems have introduced guidelines, such as requiring at least 1 in-person visit before an e-visit, to establish patient-clinician relationships [94].”
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    Premisecitation

    Another study emphasized that asynchronous communication is not suitable for everyone and everything.

    “Similar sentiments were echoed in another study, emphasizing that asynchronous communication is not suitable for everyone and everything [90].”
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60 of 60

  • The paper relies on this without support.

    The interventions and populations across included studies are sufficiently comparable to pool in meta-analysis.

    “Clinical outcomes (asthma control, quality of life, emergency department visits, and hospitalizations) from eligible randomized control trials were pooled in the meta-analysis.”

  • The paper relies on this without support.

    The usual care groups in included trials provide a valid counterfactual for asynchronous digital health.

    “we assessed the effectiveness of asynchronous digital consultations supported by other digital health functionalities on the clinical outcomes compared to usual care.”

  • The paper relies on this without support.

    The qualitative synthesis findings can be meaningfully integrated with trial outcomes to identify factors that affect intervention outcomes.

    “Implications from qualitative synthesis (preferred digital functionalities and implementation facilitators) were juxtaposed with trial findings for clinical outcomes and integrated to see if those implications had a role in improving clinical outcomes (Table 2).”

  • The paper relies on this without support.

    The Downs and Black score ranges used to categorize methodological quality as good, fair, or poor are valid.

    “Methodological quality was good in 3 studies (range: 20-25) [53,79,80], fair (range: 15-19) in 2 studies [69,76] and poor (≤14) in the other 4 studies [50,54,56,73].”

  • The paper relies on this without support.

    The included studies' outcome measures for asthma control and quality of life are comparable enough to pool in meta-analysis.

    “While our GRADE assessment reflected low to very low confidence in clinical outcomes, this was influenced by self-reported outcome measures and diverse tools for asthma control and quality of life.”

  • The paper relies on this without support.

    The usual care comparator is sufficiently consistent across included studies to allow pooling.

    “Overall, we identified a statistically significant improvement in asthma control and a reduced risk of hospitalization when comparing interventions using asynchronous digital health with usual care.”

  • The paper relies on this without support.

    The asynchronous digital health interventions included in the review are sufficiently similar to be considered together.

    “Overall, we identified a statistically significant improvement in asthma control and a reduced risk of hospitalization when comparing interventions using asynchronous digital health with usual care.”

  • The paper relies on this without support.

    The qualitative findings can be integrated with quantitative findings to produce a coherent synthesis.

    “A strength of this review is its inclusive design, encompassing various study types and integrating quantitative and qualitative findings.”

  • The paper relies on this without support.

    The review's findings are generalizable to diverse settings.

    “Our study indicates that asynchronous digital health can effectively complement or replace other consultation approaches for asthma care in diverse settings.”
9 of 9

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Systematic reviews have consistently shown that virtual care and remote symptom monitoring can improve access, patient satisfaction, symptom management, and continuity of care, particularly for rural and underserved populations.

    “Systematic reviews have consistently shown that virtual care and remote symptom monitoring can improve access, patient satisfaction, symptom management, and continuity of care, particularly for rural and underserved populations”

    From A Scoping Review of Implemented Innovations in Cancer Care: Implications for Pan-Canadian Scaling (2026) · cites this paper as [34]

    The Discussion’s Summary of Findings (page unavailable) reports improved asthma control and reduced hospitalization risk, while the Results’ patient-experience section says most patients or caregivers found asynchronous digital health accessible. The review also reports that patients liked its convenience, but it does not establish improved continuity of care or particular benefits for rural and underserved populations. Its findings are limited to asynchronous digital health in asthma care, rather than virtual care generally. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Views-and-experiences study list disagrees with its breakdown

    Minor

    Table 1's overall list for objective 3 includes [65] but omits [66], while its qualitative and mixed-methods breakdown includes [66] and not [65].

  • Asthma-control meta-analysis count includes an excluded trial

    Minor

    Table 1 lists seven studies, including [78], as included in the asthma-control meta-analysis. The results say [78] was excluded from that meta-analysis and included only in a sensitivity analysis.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Mechanic, OJ, 2022, Telehealth Systems
  2. Systematic Review Accelerator-Deduplicator2023-08-12https://sr-accelerator.com/#/deduplicator
  3. Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia2022-07-05https://www.covidence.org
  4. Deshpande, A, 2009, Open Med, 3, e69
  5. Eschler, J, 2015, AMIA Annu Symp Proc, 2015, 543

Cited by

Sorted by citations

Authors
Uzzaman, N., Hammersley, V., McClatchey, K., Sheringham, J., Singh, D., Habib, G. M., & Pinnock, H.
Affiliations
  • University of Edinburgh (GB)
  • National Health Service (GB)
  • University College London (GB)
Corresponding author
Pinnock, Hilary
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2024-12-03
Volume
26
Pages
e57708
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/57708
PMC
PMC11653041
OpenAlex
W4404948089
Semantic Scholar
c9481c6a6427517d776e4843e9ea7bbc799b3817
Cited by
13
References
80
Citations by year
2026: 12 · 2025: 1
FWCI
1.14
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Discovery Research Portal (University of Dundee) (publishedVersion, cc-by)
  • UCL Discovery (University College London) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
Funders
  • National Institute for Health and Care Research
  • Department of Health and Social Care
  • Asthma and Lung UK
  • Asthma UK Centre for Applied Research
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
asthma care, asthma reviews, asthma control, hospitalization reduction, patient acceptability, medication reminders, patient-provider communication, telemedicine, digital health implementation, quality of life
MeSH terms
Digital Health, Adult, Asthma, Humans, Patient Acceptance of Health Care, Randomized Controlled Trials as Topic, Telemedicine

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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