Telemedicine strategy effective for asthma control in children

Switching to a telemedicine-only strategy from face-to-face visits does not affect asthma control in children. Moreover, the strategy may actually increase show rates, according to a study presented at the recent ACAAI 2020 meeting.

This prospective, observational study assessed the effect of switching from the traditional face-to-face visits to an exclusively telemedicine-based approach which occurred as a result of COVID-19. The study population comprised patients aged 4–18 years in an inner-city paediatric asthma disease management system (Breathmobile). Regular patients were contacted by their specialist providers during the scheduled face-to-face visit. During the telemedicine consult, patients had their asthma history and current asthma control test (ACT) score documented, were provided with asthma action plans, and had prescriptions refilled and inhaler use techniques reinforced. 

Over the 4-month study period, >90 percent of patients maintained asthma control, with ACT scores >19 (well controlled asthma). Asthma control – both ACT scores and proportion of patients with asthma control – did not significantly differ between this period and the same time frame in 2019 (pre-COVID-19). [ACAAI 2020, abstract A060]

There was also a significant increase in show rates (parents bringing their children to an appointment) during the telemedicine-only period, beyond that achieved with face-to-face visits (p<0.05 for March–June 2020 vs March–June 2019).

A survey was conducted among staff to assess their perception of workload before and during the pandemic. Of the 12 staff surveyed, none reported having to work overtime to complete clinical work after the telemedicine-only strategy was initiated compared to when face-to-face visits were the norm pre-COVID-19. Ten of them acknowledged a perceived increased workload with the telemedicine strategy and 11 said they spent more time with each patient (32–62 percent increase) compared with the face-to-face strategy.

“The pandemic in 2020 resulted in closure of most Los Angeles schools and face-to-face visits were converted to telemedicine visits. We found that not only did kids show up for appointments, but their show rates were also significantly higher than during the same period in 2019,” said study author Dr Kenny Kwong from the Los Angeles County + University of Southern California (USC) Medical Center, Los Angeles, California, US.

The reason for the increase in staff workloads following telemedicine initiation is uncertain. Potential reasons include the novelty of the telemedicine platform that required staff to adapt or requiring more organization including coordinating between patients and providers, said Kwong.

“Kids with asthma need treatment that is consistent and specialized to their individual needs,” said co-author Associate Professor Lyne Scott from the Keck School of Medicine of USC, Los Angeles, California, US.

“It’s reassuring and encouraging that the quality of care young patients, including those in underserved populations, received via virtual access kept their asthma under control,” she said.

According to Kwong, the results suggest that this care model could potentially work for other chronic diseases in the paediatric population during emergencies or natural disasters.

“This study shows it’s possible to move towards new models of treatment that increase access and convenience for the patient, and still maintain quality of care,” contributed Scott.