New study finds combination of telemedicine and in-person visits best for asthma care
Can telemedicine improve asthma care for pediatric patients and young adults?
A new study from UC Davis Health examines the use of telemedicine in asthma patients. Researchers identify best practices that can minimize health disparities, maximize patient experience and increase access. This is the first study to evaluate the use of telemedicine between provider and patient for asthma care in children and young adults. The study was published this month in the asthma diary.
Asthma is the most common health problem among young people in the United States, affecting approximately 8% of children and young adults. Previous studies have shown that children with asthma experience more than double the number of missed school days than those without asthma.
“Because asthma is one of the most common chronic diseases of childhood, optimizing the delivery of care to families is uniquely important. We wanted to explore whether telemedicine is a practical solution for parents and patients with asthma,” said Rory Kamerman-Kretzmer, a pediatric pulmonologist at UC Davis and one of the study’s authors.
The UC Davis Pediatric Telemedicine Program was one of the first programs of its kind in the nation to provide physicians and patients with real-time remote consultation and assessment through interactive, high-speed video and audio communication. definition.
A mixed-method study using electronic health records, focus groups
Researchers analyzed the electronic health records of all patients, ages 2 to 24, who were seen at UC Davis Health for a primary diagnosis of asthma during the state-wide shelter-in-place order. State of California (March 19, 2020 through September 30, 2020). A total of 502 patients met the criteria. Of these patients, 207 had at least one telemedicine visit. Of the remaining patients, 265 had in-person visits only and 27 had telephone visits. Three had a combination of in-person and telephone visits.
Most study patients 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 primary language other than English were significantly less likely than English-speaking patients to adopt telemedicine for asthma care during the pandemic.
Because UC Davis Health serves an area of 33 counties, many patients travel great distances to get to the Sacramento clinic. In this study, more than 10% of patients traveled more than 100 miles to get to UC Davis Health.
Video visits can save time, but in-person visits are preferred for asthma patients
From the group of 502 patients, the researchers randomly selected 12 parents of pediatric patients and five young adult patients to participate in an hour-long focus group session via videoconference. Three focus groups were held.
Focus group participants were asked to compare how providers interacted with patients via telemedicine and in person. Some of the common themes and findings were:
- Parents and patients said it was difficult to build trust with a new telemedicine provider.
- Parents felt that having a doctor present in person was more effective in advising pediatric patients on the importance of medications and teaching them about asthma.
- Parents felt that pediatric patients participated more actively during the in-person visit.
- Telemedicine visits were more likely to involve a physician rather than the entire care team. The parents preferred to talk to only one doctor.
- Telemedicine has allowed parents and patients to see their specialist without spending significant travel time. Parents have also valued telemedicine visits as a way to protect their children during the pandemic.
- While some parents were willing to take lung function measurements at home, many were not confident in their ability to use home monitoring equipment like peak flow meters and home spirometers.
- All participants who used telemedicine said that scheduling follow-up appointments was more difficult than in-person appointments.
- Almost all focus group participants agreed that a combination of telemedicine and in-person visits would be best when asthma is well controlled.
Improving access and ensuring equity
Families noted that while telemedicine improved their access to care, it did not completely replace in-person visits. Parents and patients still found face-to-face visits helpful, especially when meeting healthcare providers for the first time or when receiving asthma education or medication management information. Parents also preferred that providers take patient measurements during office visits, rather than training them to use the equipment at home.
“The study shows that alternating telemedicine and in-person visits for routine asthma care is the preferred mode of care for many parents,” said Sarah Haynes, lead author of the study and assistant professor of Pediatrics at UC Davis Health.”This option balances the added convenience of telemedicine visits, while ensuring children get the physical exams and measurements they need.”
The study also highlights an important opportunity to improve health equity by increasing access to telemedicine for families with asthma who speak a primary language other than English.
The study was funded by a Children’s Miracle Network grant to UC Davis.
Study co-authors were Shahabal Khan, Stephanie Crossen, Monica Lieng, James Marcin, Nicholas Kenyon and Christopher Kim of UC Davis Health. The study was a multidisciplinary collaboration between the UC Davis Center for Health and Technology, epidemiology, pediatric pulmonology, and general pediatrics at UC Davis Health.