School-based asthma care pairs well with telemedicine

Telemedicine approaches can complement the benefit of school-based care in children with severe asthma, according to a new study published in JAMA Pediatrics.

“The telemedicine model is one form of connected care that enhances access to medical services for traditionally underserved children and was an efficient way to link children to primary care and facilitate asthma assessment and treatment,” wrote the study’s authors, led by Jill S. Halterman, MD, MPH, Department of Pediatrics, University of Rochester, Rochester, NY.

In the current trial, researchers built on their previous School-Based Asthma Therapy Study, which demonstrated the clinical benefit of directly observed therapy (DOT) of preventive medicines in school children with persistent or poorly controlled asthma between the ages of 3 and 10 years. The University of Rochester researchers are partnered with the Rochester School District to create programs for urban school children with asthma.

In their original study, the team of clinicians directly assessed patients and administered care at school. The results showed more symptom-free days (SFDs) and fewer exacerbations, but the approach proved logistically overwhelming.

In the current trial, the team developed a novel telemedicine program titled School-Based Telemedicine Enhanced Asthma Management (SB-TEAM), which permitted clinicians to remotely visit with school children. The team engaged in telemedicine visits at the beginning of the study and between 4 and 6 weeks twice thereafter.

“The SB-TEAM program uses school-based DOT of preventive asthma medications to enhance medication adherence, as well as telemedicine to ensure access to appropriate asthma assessments, preventive medication prescription, and follow-up care,” the researchers wrote.

They added: “The follow-up visits allowed for an assessment of the child’s asthma control once they were established on DOT and an opportunity to inquire about triggers or comorbid conditions that might interfere with an optimal treatment response.”

Between 2009 and 2012, the researchers recruited 400 children from 49 schools (57.5% African American; average age of 7.8 years). Following a baseline asthma assessment—including symptoms, caregiver depression, family history, and smoke exposure—the researchers randomized the children to either an SB-TEAM (n=200) or enhanced usual care (eUC) group (n=200) for one-year intervals. A permutated block design was used to balance the groups.

The primary outcome was SFDs at 4 months, 6 months, and at final follow-up. Caregivers used a symptom diary to provide feedback about SFDs during telephone interviews. The team also reviewed medical and school records.

Secondary outcomes for this study included the number of days and nights with asthma symptoms, use of rescue medications, days with limited activity, and visits to the hospital or clinic for asthma care.

In the SB-TEAM group, 98% of patients participated in one-plus telemedicine visits, and 82.5% engaged in supervised therapy at school. These children experienced more SFDs per 2 weeks than did children in the eUC group (11.6 vs 10.97; difference, 0.69; 95% CI: 0.15-1.22; P=0.01). The researchers observed the largest difference during the final follow-up. Furthermore, children in the SB-TEAM group were less likely to visit the ER or hospital for asthma treatment.

At baseline, all children experienced an average of 7.2 SFDs every 2 weeks, as well as frequent asthma symptoms and use of rescue medications. In addition, about half of all children visited the ER or were hospitalized secondary to asthma during the past year.

The researchers noted that although quality of life improved in both caregiver groups, no significant differences between the two groups were observed. More SB-TEAM caregivers endorsed the program and cited improved comfort and communication with school nurses.

“The integration of telemedicine with school-based care represents one successful method to enhance access to guideline-based treatments and ensure appropriate primary care follow-up assessments,” the researchers concluded. “As we continue to work toward sustainability of these care models, it is important to consider resources available in each community to build collaborations that can be continued.”

To read more about this study, click here.