Telehealth visits confer comparable asthma outcomes, preferred by many patients
Click Here to Manage Email Alerts
Key takeaways:
- 42% of patients preferred telehealth and 49% preferred in-person visits for regular asthma checkups.
- Patients who used telehealth and those who had in-person checkups had comparable asthma control.
Telehealth and in-person appointments for asthma led to similar outcomes, according to a study published in Annals of Allergy, Asthma & Immunology.
Also, many Black and “Latinx” adults with moderate to severe asthma preferred telehealth appointments over in-person visits for regular checkups, Juan Carlos Cardet, MD, MPH, associate professor of medicine in the division of allergy and immunology of the department of internal medicine at University of South Florida Morsani College of Medicine, and colleagues found.
“We started thinking about this project during the COVID-19 pandemic, which substantially and very quickly increased the use of telehealth for asthma,” Cardet told Healio.
“Many in our group wondered whether patients liked telehealth and, if so, what characterizes those patients who do, and how telehealth impacts asthma outcomes compared to in-person visits,” he continued.
Study design, results
The researchers conducted telephone and email interviews with 847 Black and Latinx adults with moderate to severe asthma who had been enrolled in the PREPARE study. Researchers defined the term “Latinx” as participants of Latin American or Spanish origin.
Of the respondents, 94.3% had access to cellphones with cameras, 70% had access to computers or tablets with cameras and 86.9% had internet access.
Also, 55.6% reported that they had attended both in-person and telehealth appointments as part of their asthma care.
Based on the survey, 42% preferred telehealth visits for regular asthma checkups, whereas 49% preferred in-person visits. Also, 9% had no preference.
Preferences for telehealth visits for regular asthma checkups were associated with employment (OR = 1.61; 95% CI, 1.09-2.39), lower self-reported asthma medication adherence based on the Medication Adherence Report Scale-5 (OR = 1.06 for every one-point decrease; 95% CI, 1.01-1.11) and more ED or urgent care visits in the 12 months prior to trial enrollment (OR = 1.1 for each additional visit; 95% CI, 1.02-1.18).
A greater proportion of respondents preferred in-person visits when they had new or worsening asthma symptoms (in person, 75%; telehealth, 19%; no preference, 6%) or asthma emergencies (in person, 89%; telehealth, 8%; no preference, 3%). Thus, significantly more respondents reported preferring telehealth for regular checkups compared with these other types of visits (P < .001).
Preferences for telehealth for new or worsening symptoms were associated with Spanish language preference (OR = 1.52; 95% CI, 1.11-1.75), whereas telehealth emergency visit preferences were associated with depressive symptoms (OR = 2.08; 95% CI, 1.01-4.28).
When patients had experienced both telehealth and in-person visits, 34.3% said they preferred telehealth due to visit costs, 26.4% said they preferred it because of time off from work or school, 45% said they preferred it due to arrangements for family care and 67.8% said they preferred it because of transportation to the clinic.
The researchers also collected data pertaining to outcomes from 98 respondents, including 62 with one or more telehealth visit (6.36 months of follow-up) and 36 who exclusively had in-person visits (6.42 months of follow-up).
Telehealth use was associated with sex (men, 88% vs. women, 59%), ethnicity (Latinx, 68% vs. Black, 50%), region (Southwest, 91% vs. elsewhere, 49%) and employment status (employed, 76%; unemployed, retired, disabled or other, 56%).
Telehealth use also appeared associated with controller therapy regimen, with greater use among those who only used inhaled corticosteroids vs. more complicated regimens (87% vs. 56%), as well as among those who did not use nebulizers vs. those who did (74% vs. 57%).
Respondents who used telehealth also had fewer mean ED or urgent care visits (1.1 vs. 2.2), systemic corticosteroid bursts (1.2 vs. 2.3) and asthma-related hospitalizations (0.1 vs. 0.3) in the year prior to enrollment compared with those who only had in-person visits.
When evaluating follow-up asthma control, researchers found that patients who used telehealth had comparable mean Asthma Control Test scores (18.43; standard deviation [SD], 4.34; vs. 18.93; SD, 3.83) and Asthma Symptom Utility Index scores (0.79; SD, 0.19 vs. 0.84; SD, 0.14) compared with the in-person group.
They also showed comparable mean systemic corticosteroid bursts, ED or urgent care visits and asthma-related hospitalizations during follow-up.
Conclusions, next steps
Based on these findings, the researchers called the proportion of Black and Latinx adults with moderate to severe persistent asthma who preferred telehealth visits for regular checkups substantial, with similar longitudinal outcomes between telehealth and in-person patients.
“Some of our significant findings were that more than 40% of Black and Latinx adults with moderate-to-severe persistent asthma prefer telehealth visits for regular asthma checkups, that employed individuals are more likely to prefer telehealth for regular asthma checkups, and that based on exploratory analyses, these visits might bring about similar asthma outcomes as in-person visits in this population,” Cardet said.
“The large proportion of participants that prefers telehealth makes these findings significant, especially in light of policy changes that decrease or discontinue reimbursements for asthma care provided through telehealth,” he continued.
Also, the researchers called for asthma care clinicians and policymakers to continue to make telehealth for regular asthma checkups available to these patients.
“Our results suggest that telehealth likely provides comparable quality of care as in-person visits to patients with moderate to severe asthma and that many patients prefer telehealth for regular checkups, especially those who might have barriers to accessing their asthma care provider, for example, due to conflicting commitments at work,” Cardet said. “Continuing to dismantle barriers is a way to optimize asthma care.”
The researchers would like to see further studies as well.
“Our results on asthma outcomes were exploratory,” Cardet said. “A next step would be to validate them with a larger, prospective study.”
For more information:
Juan Carlos Cardet, MD, MPH, can be reached at jcardet@usf.edu.
Perspective
Back to Top
Priya J. Bansal, MD, FAAAAI, FACAAI
I believe these findings are significant. It is important to understand that for routine asthma care, patients prefer telehealth visits. But for new or emergency visits, an in-person visit is preferred.
Lawmakers and insurance companies need to realize where patients are at this time post-pandemic to ensure these services are covered and reimbursed equally to in-person visits. Physicians need to learn how to structure their schedule to best accommodate these different visit types in the clinic.
Also, these results are similar to my own experience. With a new or emergent appointment, I like to see and examine the patient. For routine care, using quality assessments and remote patient monitoring, we can conduct these visits effectively via telemedicine platforms.
My advice for clinicians who would like to optimize their use of telemedicine would be to template the schedule accordingly to be more efficient. Going back and forth between in-office and telemedicine patients can sometimes be difficult, and time should be budgeted accordingly.
If the patient can receive the Asthma Control Test form/review of symptoms information/medication profile check prior to the visit, that will also help to facilitate a productive telemedicine visit. Also, utilizing new forms of remote patient monitoring to measure compliance and FEV1 may assist in maximizing asthma control.
The next steps in this research would be to study each of the different groups — mild intermittent, mild persistent, moderate persistent and severe asthma — to determine if preferences, compliance and control changes with severity.
I would also like to see if adding remote monitoring changes those parameters and satisfaction levels. And as this was studied in adults, I would like to expand this to the pediatric population and see if the results are similar as well.
Collapse
Read more about
Click Here to Manage Email Alerts