Telehealth Delivery of Adherence and Medication Management System Improves Outcomes in Inner-City Children With Asthma

This pilot study assessed feasibility and efficacy of a video telehealth based school program to deliver a medical and behavioral interventional program to improve asthma outcomes in inner city children with asthma.

Twenty-one children with physician-diagnosed and uncontrolled asthma in past 12 months (ACT score <20, ≥1 emergency department visits/hospitalizations or ≥2 systemic steroid bursts) were enrolled.

Over a 6 month period, enrolled children completed 7 video-based telehealth (VBT) visits conducted by an asthma specialist and 5 VBT school-based self-management visits with an adherence psychologist. All visits were done at school with the help of a school nurse or study coordinator. Electronic inhaler monitors recorded medication data and a composite asthma severity index (CASI) score with daytime, nighttime symptoms and exacerbation domains were assessed (CASI ≥ 4 severe asthma). During the monthly VBT clinical visits, physical examinations, the ACT score, asthma TreatSmart program (a computer-based decision support tool), and modified CASI were reviewed to make medication adjustments as needed. Additionally, during the self-management visits, the adherence data, barriers to adherence were reviewed and personalized support was provided to assist with text messages and reminders.

Among 21 children enrolled, median age was 13 years, 57% were males and majority (73%) were Black/African American. Most children were insured by Medicaid (85%), and 76% had a single parent in the home. Most prominent among the severe asthmatics, CASI score decreased soon after the intervention and was maintained for the duration of the study with no emergency department visits or hospitalizations during that time. ACT scores, inhaler adherence improved with reduced albuterol use in addition to reduced school absences over the study course.

A multi-component medical and behavioral VBT based intervention school program is both feasible and effective to improve adherence and asthma control among inner city children with asthma.

Healthcare disparities with racial and ethnic and economic determinants result in increased morbidity and mortality in children with asthma. Lack of adequate access to care and poor medication adherence are substantial barriers to improving outcomes. Although small with no control group, this study shows that the application of a telehealth program potentially improves asthma adherence and outcomes, especially among children with severe asthma. Programs like this may complement successful school-based interventions, including stock school inhalers and in-school medication administration programs, to further improving asthma control and medication adherence. It would be important to apply these results to a larger population in different settings with control groups to assess efficacy and sustenance of the benefits. Furthermore, this study is timely given that the coronavirus disease pandemic has required the rapid adoption of telehealth visits and remote management, modalities which will likely become a fixture in how we monitor our patients in the future.