Achieving 75% adherence in asthma and type 2 diabetes: our NHS England pilot results

The study, targeted at those with asthma or type 2 diabetes, was designed to prove if a digital health app using natural language could increase medical adherence, (up to 50% of the population fail to follow their recommended treatment plan) as well as supporting those with comorbidity (people living with two or more long term conditions).

Medical non-adherence amongst the 26 million people living with comorbidity is a growing issue, with the estimated cost in England in excess of £930 million per annum, with asthma costing £130 million and type 2 diabetes costing £100 million alone. Left untreated, those living with asthma and diabetes are more at risk of asthma attacks, heart attacks, strokes or other permanent damage.

The pilot in North Yorkshire started in May 2022 at a research-active practice within NHS England, and was targeted at those aged 18-75+ with asthma or type 2 diabetes.

The results showed:

• Active users achieved an average adherence of 75%, significantly greater than the 40-50% average adherence assumption of medicines in general
• At the start of the pilot, Aide discovered 41% stopped taking their medicine when they felt their condition was under control, in spite of it being particularly damaging for long-term health conditions such as asthma
• 33% stated that they were previously not confident about what to do if their condition changes
• 70% of people in the study continued to use Aide every day after the first month
• Medical adherence in the most improved patient in the over 70s went from 45-50% to 100% over the span of three and a half months
• The average patient completed 2-5 conversation flows per day, including logging of medicines and recording of measurements through natural language, enabling live data to be shared with their clinician
• It takes 15 seconds on average for the majority of users to report a symptom

Using natural language, Aide has short, daily conversations with patients who have asthma or type 2 diabetes, to help them manage their day-to-day health. The app helps to improve their relationship with their medicine, record monitoring for things such as blood pressure and blood glucose, and provides structured education. Co-founder and CEO Ian Wharton suffered from asthma and anaemia from a young age, which often were managed poorly due to the lack of structure and support provided, leading to the creation of Aide.

Dr Thiagarajan at Pickering Medical Practice said:

As a research-active practice, we are excited to explore how new technologies can support our population. Our patients found the natural language element of Aide easy to use and it’s promising to see that those in their 70s use the app daily and have their adherence improve. I can see a significant role for Aide to enable the patient to take control of their long-term conditions in an individualised and patient-centred way.

Following taking part in the study, Louise with type 2 diabetes, aged 34, said:

Having Aide means that we are taking a partnership approach to my health. This would mean the power is more balanced and that my clinician is able to see me as a person with a life rather than just my condition.

Christine, 61, added:

I’ve had asthma for around 20 years. Aide reminds me to take my preventer inhaler regularly, particularly when symptoms are mild and I may forget to take it. It’s been very helpful these past months.

Professor Nick Barber, Head of Clinical Outcomes at Aide, said:

There is a great unmet need amongst patients with long-term conditions – to be helped to understand their medicines and to take them reliably. This is just the start of a longer journey to helping clinicians understand the patient’s relationship with medication in order to help those who are most in need of it. However, the early results are already promising. Aide provides daily friendly support that should help them manage their conditions more effectively.

Aide is next being introduced to patients in a Primary Care Network in England to help reduce the over-use of reliever inhalers for asthma and improve self-management. More conditions will be added to the app within the next year.