Telemedicine program reduces ER visits for students with asthma

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The University of Rochester Medical Center has partnered with the Rochester City School District to ensure that students with asthma receive the appropriate medication therapy through a telemedicine approach that enables visits from the children’s primary care providers to aid in-school nurses.

“We know that asthma is a significant problem particularly for kids living in the city in terms of causing ongoing symptoms, missed school days and emergency visits,” says Jill Halterman, MD, chief of the Division of General Pediatrics at URMC. “We also know that a lot of kids aren’t getting medications that might have prevented these symptoms.”

In a study, URMC and researchers from Johns Hopkins School of Medicine and University of Arkansas for Medical Sciences enrolled 400 students between the ages of 3 and 10 in Rochester, N.Y., to measure the impact of a school-based intervention—including supervised asthma therapy and telemedicine visits—on urban children with asthma.

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What they found in the randomized clinical trial was that children who received a combination of telemedicine support and school-based medication therapy were almost half as likely to need an emergency department or hospital visit for their asthma. With one in 10 children in the United States diagnosed with asthma, it is the most common chronic childhood disease.

Results of the study, funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health, were published this week in JAMA Pediatrics.

“Clinicians and researchers across the country are designing similar programs, using resources available in their communities to reach underserved children with asthma and help them get needed assessments,” adds Halterman, the study’s lead author, who contends that the Rochester program could be used as a model for asthma care among school-aged kids in cities.

“But regardless of how you’re reaching them initially, those children may continue to have issues if they aren’t taking their medications regularly,” she warns. “The integration of telemedicine with supervised treatment through school provides one model to ensure that children receive consistent, effective asthma treatment.”

According to Halterman, the school-based telemedicine visits were completed by clinical telehealth assistants, who met with the children and set up virtual visits by connecting to primary care providers in their own offices for the purpose of assessing the therapy needed for asthma.

“These data were stored in a secure virtual waiting room and then viewed by the primary care clinician, who completed the assessment and communicated with caregivers via videoconference or telephone,” states the article. “Preventive medication prescriptions were sent to pharmacies that deliver to schools for supervised daily administration.”

“It’s a great system because the child doesn’t have to miss school, the parent doesn’t have to miss work, and the provider can be in their usual workplace,” concludes Halterman, who notes that a separate study is being implemented to evaluate a program tailored to adolescents.

Going forward, researchers are trying to determine how to make this type of program sustainable by conducting a cost analysis “to figure out how much it actually cost to make this happen and how much we saved by preventing emergency visits and hospitalizations,” she says.

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