Telemedicine expands reach of asthma practices

Key takeaways:

• School-based monitoring led to more symptom-free days and fewer ED visits.
• Errors in inhaler technique decreased with telemedicine evaluations.
• 86% of telemedicine spirometry tests were interpretable.

SAN ANTONIO — Providers can use telemedicine to engage patients with asthma who face obstacles in access to care remotely, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

“You can use a telemedicine encounter as a way to increase your presence at your hospital or to help a rural hospital,” Allison C. Ramsey, MD, FACAAI, FAAAAI, clinical assistant professor of medicine, University of Rochester, said during her presentation.

For example, the University of Rochester’s School-Based Telemedicine Enhanced Asthma Management program works with the Rochester City School District, which uses a store-and-forward telemedicine system.

Allison C. Ramsey

Researchers from the university conducted one or more telemedicine visits with 195 children aged 3 to 10 years at high risk for asthma in the school district, including a medical history and examination data that was stored in a secure virtual waiting room.

A primary care physician then assessed the data and communicated with the child’s caregiver via videoconference or telephone. Prescriptions were sent to pharmacies and delivered as needed to schools, where they were administered. Meanwhile, 186 children at high risk for asthma received enhanced but usual care through the school.

“The telemedicine group had more symptom-free days as compared to the usual care group. They also had higher use of their preventive medications because they’re being monitored,” Ramsey said. “They also had less ED visits and hospitalizations.”

For example, the telemedicine group had 11.6 symptom-free days and the enhanced but usual care group had 10.97 symptom-free days, both per 2 weeks postintervention (OR = 0.69; 95% CI, 0.15-1.22).

Preventive medication prescriptions included 91% of the telemedicine group and 67.3% of the enhanced but usual care group (OR = 8.67; 95% CI, 4.19-17.95). Also, 7% of the telemedicine group and 14.8% of the enhanced but usual care group reported one or more ED visits (OR = 0.52; 95% CI, 0.32-0.84).

“This is a really unique model because as we know, it’s hard for families, especially in these underserved areas, to get their kids to the doctor when there’s a lot of competing priorities,” Ramsey said. “So, this is a way where, if the kids are already going to be at school, this is a way to monitor their asthma.”

Telemedicine can be used to monitor inhaler technique at home in real time or with store-and-forward technology among high-risk patients with asthma and COPD as well, Ramsey continued.

In another study, 42 patients with long-term prescriptions participated in 91 initial inhaler telemedicine evaluations via a tablet with a camera. Physicians monitored their inhaler technique in real time or via stored and forwarded video. During the evaluations, the physicians found 71 errors.

“Fifty percent of these errors were critical, meaning they’re not getting the medicine they need,” Ramsey said. “These are the high-risk patients who are at high risk enough to be in a home health monitoring program.”

With a median delay of 256 days, 81 follow-up evaluations for 39 patients found 32 errors (P < .001), including seven critical errors (P = .0017).

“Nobody’s perfect, but it’s an improvement in 39 patients and only 22% were critical,” Ramsey said.

Spirometry can be part of telemedicine as well, Ramsey continued, citing a study in rural Arkansas where nurses performed 50 spirometry tests for 38 pediatric patients with asthma at remote sites instead of having them travel to tertiary care centers.

Using telemedicine, a registered respiratory therapist at the tertiary care center coached pediatric patients through the spirometry test, and 86% of the tests were interpretable by a pediatric pulmonologist.

“I don’t think we get these results with in-person spirometry,” Ramsey said, adding that it is another avenue for specialists to improve their reach into rural areas.

Finally, Ramsey cited a review indicating improvements in fractional exhaled nitric oxide and inhaler technique among a pediatric population via educational telemedicine interventions, as well as reduced symptoms and fewer school absences with no changes in pulmonary function.

“In general, patients are satisfied with this, and there’s an improvement in quality of life,” Ramsey said.

References:

• Berlinski A, et al. J Allergy Clin Immunol Pract. 2018;doi:10.1016/j.jaip.2018.01.032.
• Culmer N, et al. J Allergy Clin Immunol Pract. 2020;doi:10.1016/j.jaip.2022.02.005.
• Halterman JS, et al. JAMA Pediatr. 2018;doi:10.1001/jamapediatrics.2017.4938.
• Trosini-Désert V, et al. Telemed J E Health. 2020;doi:10.1089/tmj.2019.0246.