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Effect of the Telemedicine Enhanced Asthma Management-Uniting Providers (TEAM-UP) Program on Asthma Outcomes: A
Jill S Halterman1, Maria Fagnano1, Paul J Tremblay1
1Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Insights
A school-based intervention combining telemedicine and observed therapy improved asthma control in children. This approach increased symptom-free days and reduced emergency visits for children with persistent asthma.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Digital Health
Background:
- Asthma is a common chronic respiratory disease in children, often requiring ongoing management.
- Moderate-to-severe persistent asthma significantly impacts children's quality of life and healthcare utilization.
- Underserved communities face unique challenges in accessing consistent asthma care.
Purpose of the Study:
- To evaluate a school-based intervention for children with moderate-to-severe persistent asthma.
- To assess the impact of integrating telemedicine consultations with school-based directly observed therapy (DOT) for preventive asthma medications.
- To optimize asthma management and reduce healthcare use in pediatric populations.
Main Methods:
- A randomized controlled trial involving 326 children aged 4-12 years with poorly controlled asthma.
- Intervention group: Telemedicine Enhanced Asthma Management-Uniting Providers (TEAM-UP) with daily school-based DOT and specialist telemedicine visits.
- Control group: Enhanced usual care. Primary outcome: Mean symptom-free days per 2 weeks.
Main Results:
- Children in the TEAM-UP group experienced significantly more symptom-free days (mean difference: 1.32 days/2 weeks).
- The TEAM-UP intervention was associated with reduced school absenteeism (OR: 0.70) and fewer emergency department visits or hospitalizations for asthma (OR: 0.54).
- High participation in specialist visits (84%) and DOT (74%) was observed in the intervention group.
Conclusions:
- The TEAM-UP intervention significantly improved asthma symptom control in children.
- This model effectively reduced healthcare utilization, including emergency visits and hospitalizations.
- School-based telemedicine combined with DOT offers a promising strategy for asthma care in underserved communities.
Objective:
To evaluate a school-based intervention for children with moderate-severe persistent/poorly controlled asthma, adding telemedicine consultations with specialists to school-based directly observed therapy of preventive asthma medications in order to optimize management.
Study Design:
From 2018 to 2024 children aged 4-12 years with moderate-severe/poorly controlled asthma were randomized to Telemedicine Enhanced Asthma Management-Uniting Providers (TEAM-UP) or enhanced usual care. TEAM-UP included daily school-based directly observed therapy and telemedicine visits with asthma specialists. The primary outcome was mean symptom-free days/2 weeks. Analyses used linear mixed and generalized estimating equation models.
Results:
We enrolled 326 children (62% participation; mean age 8.4 years; 60% male; 58% Black; 35% Hispanic; 80% Medicaid). The majority (84%) of TEAM-UP participants had ≥1 specialist visit and 74% received school-based DOT (excluding the pandemic). We found that children in TEAM-UP vs enhanced usual care had more symptom-free days (mean difference: 1.32; 95% CI 0.58-2.05) and were less likely to miss school (odds ratio: 0.70; 95% CI 0.52-0.96) or require emergency department visits or hospitalizations for asthma (odds ratio: 0.54; 95% CI 0.31-0.96).
Conclusions:
TEAM-UP significantly improved asthma symptoms and reduced health care use, offering a promising model for asthma care in underserved communities.
Trial Registration:
ClinicalTrials.gov number: NCT03545906 https://clinicaltrials.gov/study/NCT03545906?term=NCT03545906&rank=1.
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