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Effect of the Telemedicine Enhanced Asthma Management Through the Emergency Department (TEAM-ED) Program on Asthma
Jill S Halterman1, Maria Fagnano1, Paul Tremblay1
1Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Insights
A telemedicine program improved asthma follow-up care for children after emergency department visits. While prepandemic data showed improved symptom-free days, overall morbidity and adherence did not change, indicating a need for ongoing support.
Area of Science:
- Pediatric Emergency Medicine
- Digital Health Interventions
- Asthma Management
Background:
- Emergency department (ED) visits for pediatric asthma are common.
- Effective follow-up care is crucial for managing persistent asthma in children.
- Guideline-based care and primary care integration can reduce asthma morbidity.
Purpose of the Study:
- To evaluate the effectiveness of a telemedicine program in reducing asthma morbidity in children post-ED visit.
- To improve primary care follow-up rates and guideline-based asthma care delivery.
- To assess the impact on symptom-free days and medication adherence.
Main Methods:
- Randomized controlled trial involving children (3-12 years) with persistent asthma presenting to the ED.
- Intervention group received Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED), including school-based telemedicine and additional follow-ups.
- Control group received enhanced usual care. Primary outcome: mean number of symptom-free days (SFDs) over 2 weeks.
Main Results:
- The TEAM-ED program significantly increased follow-up visits and preventive asthma medication actions compared to usual care.
- Children in TEAM-ED showed higher rates of preventive medication use.
- No significant differences were observed in overall medication adherence or asthma morbidity between groups.
- Prepandemic data indicated greater improvement in SFDs for the TEAM-ED group.
Conclusions:
- The TEAM-ED program effectively enhanced post-ED visit follow-up and preventive care for pediatric asthma.
- Improved symptom-free days were noted in prepandemic data, suggesting potential benefits.
- The lack of overall improvement in morbidity and adherence highlights the need for sustained management support beyond the intervention.
Objective:
To test the effectiveness of a telemedicine-based program in reducing asthma morbidity among children who present to the emergency department (ED) for asthma, by facilitating primary care follow-up and promoting delivery of guideline-based care.
Study Design:
We included children (3-12 years of age) with persistent asthma who presented to the ED for asthma, who were then randomly assigned to Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED) or enhanced usual care. TEAM-ED included (1) school-based telemedicine follow-ups, completed by a primary care provider, (2) point-of-care prompting to promote guideline-based care, and 3) an opportunity for 2 additional telemedicine follow-ups. The primary outcome was the mean number of symptom-free days (SFDs) over 2 weeks at 3, 6, 9, and 12 months.
Results:
We included 373 children from 2016 through 2021 (participation rate 68%; 54% Black, 32% Hispanic, 77% public insurance; mean age, 6.4 years). Demographic characteristics and asthma severity were similar between groups at baseline. Most (91%) TEAM-ED children had ≥1 telemedicine visit and 41% completed 3 visits. At 3 months, caregivers of children in TEAM-ED reported more follow-up visits (66% vs 48%; aOR, 2.07; 95% CI, 1.28-3.33), preventive asthma medication actions (90% vs 79%; aOR, 3.28; 95% CI, 1.56-6.89), and use of a preventive medication (82% vs 69%; aOR, 2.716; 95% CI, 1.45-5.08), compared with enhanced usual care. There was no difference between groups in medication adherence or asthma morbidity. When only prepandemic data were included, there was greater improvement in SFDs over time for children in TEAM-ED vs enhanced usual care.
Conclusions:
TEAM-ED significantly improved follow-up and preventive care after an ED visit for asthma. We also saw improved SFDs with prepandemic data. The lack of overall improvement in morbidity and adherence indicates the need for additional ongoing management support.
Trial Registration:
NCT02752165.
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