Using telehealth to combine the efforts of school nurses with the knowledge of a PCP yielded better outcomes for children with asthma in a poor urban environment.
Beyond being a potent health tool for various chronic conditions, telehealth can also bring better care to populations that have not had access to it in the past. While many in healthcare may first think of telehealth's benefit to rural populations, there are also substantial issues of access in impoverished urban areas that it could help address.
A recent study explored whether telehealth could be used in tandem with health aides and school nurses to improve asthma care for children in the city, and results were encouraging.
The randomized trial was conducted through a partnership between the Rochester City School District in Rochester, NY, and the University of Rochester. At the beginning of a school year, 400 children with persistent asthma were split into 2 groups: All received their required medication (often daily and in-school to ensure adherence), but those sorted into the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) program also underwent follow-up telemedicine assessments with their primary care physician (PCP) 4 to 6 weeks after baseline, and then another 4 to 6 weeks later.
The study team nurse reviewed telehealth assessments to “ensure efficient completion of guideline-based care, including appropriate prescription of preventive medications,” and relay any potential discrepancies back to the administering telehealth clinician. The PCPs were given symptom and screening assessments for the SB-TEAM group at baseline, and we encouraged to provide education and make guideline-based treatment adjustments dependent on need.
Students in the telehealth group saw noticeably better health outcomes, as measured by symptom-free days (SFD) following intervention. Those children reported slightly more mean SFDs at the 4-month follow-up, a gap that continued to widen through the 6-month follow-up and the final assessment at the end of the school year to a difference of almost 1 full day. Given that the children in the control group likely received better care than they would have otherwise, the authors also suggest the potential for a conservative bias.
The study emphasizes the importance of school nurses and health aides for the study’s purposes, and for overall childhood health management in impoverished areas. Students who participated overwhelmingly came from families with single caregivers, and tobacco smoke exposure was observed in nearly half of their households.
The researchers wrote that they “suspect that the benefits related to supervised medication administration reach beyond simply assuring adherence…and include the therapeutic relationships that were built between students and school nurses.”
While nurses and aides can help, they are often in short supply—many work in multiple schools or even school districts, and they reported a preference for delivering preventative care to the children they serve. Linking them to children’s PCPs through telehealth may have acted like a force-multiplier for their efforts.
“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 in this study,” researchers wrote.
The study, "Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity," was published online in JAMA earlier this month.