Can telemedicine improve asthma treatment in pediatric and young adult patients?
A new UC Davis Health study reviews the use of telemedicine in asthmatics. Researchers identify best practices that can minimize health inequalities, maximize patient experience, and increase access. This is the first study to evaluate the use of telemedicine from healthcare providers to patients in the treatment of asthma in children and young adults. This study is this month Asthma Journal..
Asthma is the most common health condition among young people in the United States, affecting about 8% of children and young adults. Previous studies have shown that children with asthma experience more than twice as many days of absence as children without asthma.
“Asthma is one of the most common chronic illnesses in childhood, so optimizing the delivery of care to the family is very important. Telemedicine is useful for parents and patients in need of asthma treatment. I wanted to find out if it was a good solution, “said Rory Kamerman-Kretzmer, a pediatric pulmonologist and research author at the University of California, Davis.
The University of California, Davis Pediatric Telemedicine Program was one of the first of its kind in the country to provide real-time telemedicine and evaluation to physicians and patients through interactive high-definition video and audio communications.
Mixed method research using electronic health records and focus groups
Researchers aged 2 to 24 years were seen at the University of California, Davis for a primary diagnosis of asthma during the California-wide shelter-in-place order (March 19, 2020-September 30, 2020). Electronic health records of all patients were analyzed. A total of 502 patients met the criteria. Of these patients, 207 received at least one telemedicine visit. Of the remaining patients, 265 had only direct visits and 27 had telephone visits. The three combined face-to-face and telephone visits.
Most patients in this study were male (57.6%), lived in urban areas (85.5%), spoke English as their primary language (96%), and had private insurance (65.5%). .. Patients who spoke a first language other than English were far less likely to adopt telemedicine for asthma treatment during pandemics than those who spoke English.
As UC Davis Health serves the 33 county areas, many patients travel long distances to reach Sacramento’s clinic. In this study, more than 10% of patients traveled more than 100 miles to reach the University of California, Davis.
Video visits can save time, but direct visits are recommended for asthma patients
The researchers randomly selected 12 parents of pediatric patients and 5 young adult patients from a group of 502 patients and participated in a one-hour focus group session through a video conference. Three focus groups were held.
Focus group participants were asked to compare how providers interacted directly with patients through telemedicine. Some of the common themes and findings are:
- Both parents and patients have stated that it is difficult to establish trust and relationships with new providers regarding telemedicine.
- Parents felt that the face-to-face presence of a doctor was more effective in counseling pediatric patients about the importance of medication and teaching them about asthma.
- Parents felt that the pediatric patient was more actively involved when the visit was made directly.
- Telemedicine visits were likely to involve a single physician rather than the entire care team. Parents preferred to talk to only one doctor.
- Telemedicine allowed parents and patients to see a specialist without spending significant travel time. Parents also appreciated telemedicine visits as a way to protect their children during a pandemic.
- Some parents were willing to take respiratory function measurements at home, but many were not confident in their ability to use home monitoring devices such as peak flow meters and home spirometers.
- All participants who used telemedicine said that scheduling follow-up appointments was more difficult than direct appointments.
- Participants in almost all focus groups agreed that a combination of telemedicine and face-to-face visits would be preferable if asthma was well managed.
Improving access and ensuring fairness
The family said telemedicine improved access to care, but did not completely replace direct visits. Parents and patients found value in direct visits, especially when meeting care providers for the first time, or when receiving information on asthma education and dosing management. Parents also preferred to take patient measurements during office visits, rather than training care providers on how to use the equipment at home.
Sarah Heinz, chief professor of pediatrics at the University of California, Davis, said: “This option balances the convenience of telemedicine visits with ensuring that children receive the necessary physical examinations and measurements.”
The study also highlights important opportunities to improve health equity by increasing access to telemedicine for families dealing with asthma who speak a first language other than English.
This study was funded by a network of children’s miracles with a grant from the University of California, Davis.
The co-authors of this study were Shahabal Khan, Stephanie Crossen, Monica Lieng, James Marcin, Nicholas Kenyon, and Christopher Kim at the University of California, Davis. This study was an interdisciplinary collaborative study between the University of California, Davis Health and Technology, Epidemiology, Pediatric Pulmonology, and the University of California, Davis General Pediatrics.
