Telemedicine Effective in Pediatric Asthma During Pandemic

Telemedicine was found to be effective in addressing the medical and social needs of the pediatric patient population of the asthma program at a tertiary medical center. Providers wrote of their experience with virtual care in The Journal of Allergy and Clinical Immunology: In Practice.

Telemedicine services were implemented at the onset of the COVID-19 pandemic, and asthma was identified as a potential risk factor for more severe COVID-19, necessitating the creation of remote access to asthma care.

The hospital practice primarily cares for Black and Latino/a/e children living in urban areas, with over 74% of patients insured by Medicaid. The practice consists of a multidisciplinary primary care team that provides case management, asthma education, support for patients and families, and resources to address unmet social needs, including financial hardship, food insecurity, and substandard housing. These social determinants of health (SDOH) significantly influence both the prevalence and severity of pediatric asthma and have been worsened by the COVID-19 pandemic.

Outreach via telemedicine focused on the highest-risk patients and asked about medication refills, reinforced strategies for asthma management, and provided education on COVID-19. For the intervention, patients were classified into 7 groups, according to risk: Group 1, high risk (n = 210); Group 2, severe persistent asthma (n = 42); Group 3, on biologic agents (n = 31); Group 4, moderate persistent asthma (n = 414) ; Group 5a, mild persistent asthma/high risk (n = 157/845); Group 5b, mild persistent asthma/rising risk (n = 137/845); Group 6, remaining patients with mild persistent asthma (n = 597); and Group 7, intermittent asthma (n = 938). The program covered by this study ran from April 1 to July 31, 2020.

In particular, patients were classified as high risk if they met the following criteria:

• Had severe persistent asthma, based on National Heart, Lung, and Blood Institute guidelines
• Had an emergency department (ED) visit or were hospitalized in the last 12 months
• Required monthly biologics for asthma symptom control
• Classified as high risk due to the presence of SDOH

Approximately 77% of patients with severe persistent asthma, approximately 61% with moderate persistent asthma, and approximately 78% with mild persistent (or high-risk) asthma were successfully connected with virtual outreach.

Providers then scheduled patients for a preventive visit either via video or telephone. Compared with the same period from before the pandemic, providers were able to reach a greater number of patients and families via telemedicine. They also observed a decrease in ED visits and hospitalizations in their patients.

In addition, about 1 in 5 families with unmet social needs received references to resources for transportation, food and supplies, clothing, utilities, and rent. Families responded positively to the shift to telemedicine as they were able to connect with social work and resource teams to gain access to food delivery services, gift cards for groceries, and mental health support. Other benefits included saving travel time and having flexibility in scheduling appointments around personal schedules.

Overall, there were 266 visits during phase 1 of the pandemic compared with 152 from the same period in 2019, for a 75% increase. In addition, families with unmet social needs accounted for approximately 20% of the documents resource touch points made.

The providers observed several limitations of telemedicine visits. Virtual respiratory assessments are difficult to perform, the technology posed a learning curve for both families and providers and required considerable administrative support, some families experienced limited or no access to technology and WiFi, and minimal interpreter services presented a challenge for families with limited English proficiency.

The providers detailed three patient cases in order to illustrate the benefits of using telemedicine in their practice. The first case involved a 14-year-old Latino male with severe persistent asthma and frequent ED visits and hospitalizations. Unmet social needs prevented the patient from attending in-person visits. However, equipped with a tablet and free access to WiFi for telemedicine visits, the patient and his family were able to attend medical visit and access resources addressing social needs. As a result, the patients had no urgent care visits, hospitalizations, or ED visits during the pandemic.

Another case discused a 9-year-old male with moderate persistent asthma living in a home with lack of heat, mice, cockroaches, mold infestation, and humidity. The patient and his family were able to access resources to alleviate these environmental triggers, and the patient experienced no asthma exacerbations during the pandemic.

A third case focused on a 10-year-old Latina female with moderate persistent asthma who received a COVID-19 diagnosis. Telemedicine visits allowed for ongoing support and continued monitoring, relieving anxiety experienced by the patient and her family.

For the asthma program to continue to make progress, the providers noted 2 principal needs: better documentation of the unmet social needs of their patients and track connections with resources provided by the practice. In this way, providers may be able to better evaluate the impact of SDOH on patients’ asthma-related needs.

Reference

Justvig SP, Haynes L, Karpowicz K, et al. The role of social determinants of heath in the use of telemedicine for asthma in children. J Allergy Clin Immunol Pract. Published online July 18, 2022. doi:https://doi.org/10.1016/j.jaip.2022.07.005