Overview: A recent study from the Journal of the American Medical Association(JAMA) Pediatrics indicates that combining a combination of occasional telemedicine visits with a monitored "at-school" asthma medication regimen as directed by the telemedicine providers significantly increased the number of days without symptoms for the children as well as cutting in half the number of emergency department visits or hospitalizations for asthma.
This intervention called the School-Based Telemedicine Enhanced Asthma Management(SB-TEAM) program involved 400 school children in the Rochester, New York school district. Children were randomized to either "enhanced usual care" or to SB-TEAM protocols. The SB-TEAM protocol used what is known in the telemedicine world as "Store and Forward" where documentation, images, and or video is collected and stored in a digital format then forwarded to a medical provider who reviews the information and makes a clinical decision based upon what was forwarded to them.
In this study, children in the SB-TEAM group were interviewed and examined by a Telemedicine Assistant, has some lung function testing done, and documented this information electronically and forwarded it to the telemedicine provider. After the initial telemedicine evaluation, students received a prescription for preventative asthma medications and they also received daily observed therapy for their asthma. Follow-up telemedicine evaluations were conducted every 4-6 weeks. By comparison, the "enhanced usual care" group received a evaluation of the symptoms, medication recommendations, and educational materials. This group would follow-up with their usual healthcare providers outside of school.
Results: The researchers found that the SB-TEAM students had more symptom-free days (11.6 vs 10.97) and fewer emergency department visits or hospitalizations for asthma (7% vs 15%). Caregivers of the children also reported being highly satisfied with the program, including having a better understanding of asthma medications and better communication and comfort with the school nurse.
My takeaway: The potential for improving the health of children nation-wide is massive. This is one of several small studies starting to show the benefit of having a patient and family friendly telemedicine program that can intervene early in the course of an acute issue or manage a chronic issue at the location of need. This location of need for children is usually at home or at school and the care can easily be brought directly to these locations as long as the technology and the will to do things a little different than in the past is there. Less interruption of the lives of children and caregivers while enhancing the care should lead to significant reductions in expensive ER and hospital treatments and admissions.
