Adherence to Prescribed E-Diary Recording by Patients With Seasonal Allergic Rhinitis: Observational Study

Abstract

Background: Complete diagnosis and therapy of seasonal allergic rhinoconjunctivitis require evidence that exposure to the sensitizing pollen triggers allergic symptoms. Electronic clinical diaries, by recording disease severity scores and pollen exposure, can demonstrate this association. However, patients who spontaneously download an e-diary app show very low adherence to their recording.

Objective: The objective of our study was to assess adherence of patients with seasonal allergic rhinitis to symptom recording via e-diary explicitly prescribed by an allergist within a blended care approach.

Methods: The @IT-2020 project is investigating the diagnostic synergy of mobile health and molecular allergology in patients with seasonal allergic rhinitis. In the pilot phase of the study, we recruited Italian children (Rome, Italy) and adults (Pordenone, Italy) with seasonal allergic rhinitis and instructed them to record their symptoms, medication intake, and general conditions daily through a mobile app (Allergy.Monitor) during the relevant pollen season.

Results: Overall, we recruited 101 Italian children (Rome) and 93 adults (Pordenone) with seasonal allergic rhinitis. Adherence to device use slowly declined during monitoring in 3 phases: phase A: first week, ≥1267/1358, 90%; phase B: second to sixth week, 4992/5884, 80% to 90%; and phase C: seventh week onward, 2063/2606, 70% to 80%. At the individual level, the adherence assessed in the second and third weeks of recording predicted with enough confidence (Rome: Spearman ρ=0.75; P<.001; Pordenone: ρ=0.81; P<.001) the overall patient adherence to recording and was inversely related to postponed reporting (ρ=-0.55; P<.001; in both centers). Recording adherence was significantly higher during the peak grass pollen season in Rome, but not in Pordenone.

Conclusions: Adherence to daily recording in an e-diary, prescribed and motivated by an allergist in a blended care setting, was very high. This observation supports the use of e-diaries in addition to face-to-face visits for diagnosis and treatment of seasonal allergic rhinitis and deserves further investigation in real-life contexts.

Keywords: blended care; e-Diary; mobile health; pollen; precision medicine; seasonal allergic rhinitis.

Figure 1

Graphical representation of definitions used in this study. The box line represents the monitored period (each box is a specific day) of a hypothetical participant. In this example the medical doctor, according to the individual participant’s clinical history, invited the patient to fill in the e-diary questionnaire for 54 days (prescription period). The patient started to record symptoms 6 days after the prescribed beginning day (delayed reporting start) and finished recording symptoms 5 days before the prescribed ending day (advanced reporting end). Thus, the reporting period lasted 43 days, during which the participant did not fill in the e-diary questionnaire for 7 days (missing reporting days). Overall, the participant filled in the e-diary questionnaire for 36 days (reporting days).

Figure 2

Adherence (%) by reporting day and study center. It is possible to describe three phases (indicated by light background color): the first phase (A), lasting 6 days, during which adherence fell from 100% to 90%; the second phase (B), lasting approximately 20 days, during which adherence fluctuated until reaching 88%; and the final phase (C), during which it slowly declined to 80%. RM: Rome; PN, Pordenone.

Figure 3

Correlation between adherence achieved between the seventh and the 21st reporting days and total reporting period adherence, by study center: (A) Rome (n=101); (B) Pordenone (n=93).

Figure 4

Correlation between postponed reporting (%) and total reporting period adherence (%) by study center: (A) Rome (n=101); (B) Pordenone (n=93).

Figure 5

Mean visual analog scale (VAS) score, Rhinoconjunctivitis Total Symptom Score (RTSS), and combined symptom and medication score (CSMS) by time considering the local whole season of grass pollen in (A) Rome (n=101) and (B) Pordenone (n=93; see Figure 2 and Table 2 for definitions).

Figure 6

Mean (95% CI) adherence to recording of the e-diary during the pollen season in children affected by seasonal allergic rhinitis in (A) Rome and (B) Pordenone. Adherence was calculated for each patient considering the total reporting period and according to whole, peak, and high days of pollen periods defined by the European Academy of Allergy and Clinical Immunology (EAACI) and local criteria. See Figure 1 and Table 2 for criteria. "a" indicates that nonparametric Friedman test for repeated measures was applied and only statistically significant P values of multiple comparisons, adjusted by Bonferroni correction, are highlighted.