Telehealth can close gaps in chronic asthma care

John Bian, PhD

Kathryn K. Cristaldi, MD, MHS

Telehealth programs may not be a complete solution when it comes to closing gaps in care, but it can be helpful when it comes to managing chronic conditions like asthma.

According to a recent study published in JAMA Pediatrics that sought to investigate whether telehealth programs could be used to improve access to care for rural patients, telehealth wasn’t particularly effective in preventing emergency department (ED) visits but it still offered health benefits to the patients who used it.

There has been little research so far about the benefits of telehealth for pediatric populations, particularly among pediatric populations with chronic disease. However, there has been evidence to support telehealth in improving health management for adults with chronic disease. The American Academy of Pediatrics (AAP) has endorsed school-based telehealth services to help close gaps in care for children with chronic pediatric diseases, particularly because asthma is associated with substantial morbidity and high rates of school absenteeism.

The study suggests that the benefits of the telehealth program are multidimensional, complementing the work of local clinicians to help with disease management and medication adherence.

John Bian, PhD, an associate professor at the Medical University of South Carolina (MUSC) in Charleston, and lead author of the report, says the study is the first to test and demonstrate the efficacy of school-based telehealth programs to help close gaps in care for rural and medically-underserved communities.

“The reasons for the benefit to children with asthma from this telehealth program may be multidimensional. A combination of the telehealth services connectivity of pediatric providers to children with asthma, better medication adherence, and involvement and education of school nurses may all contribute to the success of this program,” Bian says. “In addition, the South Carolina Medicaid payment policy of school-based telehealth services may also contribute to the program’s success.”

Researchers studied more than 230,000 children aged 3 to 17 years who were enrolled in Medicaid across 5 rural counties in South Carolina, enrolling these children in 1 of these counties in a school-based telehealth program. One subset of the cohort with asthma was investigated specifically, according to the report, to determine the use of telehealth in managing exacerbations and general health.

Children in the county where telehealth services were offered had similar ED visits as the control. In the intervention county, mean monthly ED visits were 3.65% before the telehealth program was started, and 3.87% after. In the control counties, mean visits were at 3.37% before the program was started and 3.56% after. For children with asthma, mean ED visits were at 3.16% before the telehealth program and 3.38% after in the intervention county, and 3.02% and 3.9%, respectively, in the control counties. Additional analysis, however, showed that while there were no associations between telehealth programs and overall ED visits, the asthma cohort had a reduction of 0.66 percentage points per 100 children per month in ED visits-a relative 21% decrease.

The report also showed that benefits of the telehealth program increased along with the duration of the program, with the greatest benefits noted in the third year of the intervention. There were insignificant reductions in ED visits in the first 2 years of the program, the study notes, but ED visits declined by 1.11 percentage points per 100 children per month-a 35% decrease-in the third year of the program.

Kathryn K. Cristaldi, MD, MHS, medical director for school-based health and assistant professor of pediatrics at MUSC and co-author of the report, says school-based telehealth services can benefit patients as an extension of the medical home, particularly when it comes to managing chronic conditions like asthma.

“We hope that this report will inspire both increased implementation and uptake of school-based telehealth programs, as well as increased evaluation of the effects of these programs at the population level,” Cristaldi says. “Related policy changes to support widespread adoption would also help to realize the ultimate goal of seeing these kinds of programs help as many children as possible.”