Asthma affects nearly 6 million children in the United States, with annual school absences of 13.8 million days and health expenses of $800 per year per family. With limited access to healthcare in rural locations and underserved communities, telemedicine in a school-based setting involving partnerships between a child with asthma and a healthcare provider can provide patients with the opportunity to better manage chronic conditions, communicate among partners, and collaborate for solutions. We believe these partnerships can also give rise to condition-related educational opportunities.
Identifying Benefits & Challenges
We published a systematic review in The Journal of Allergy and Clinical Immunology: In Practice that examines outcomes for school-aged children with asthma and their families involving asthma-based telemedical education. Community and school-based partnerships are a promising solution for developing effective asthma management. Such programs provide effective asthma management instruction by supporting the needs of children with asthma with the resources of specific healthcare services. Overall, telemedicine solutions paired with school-based asthma care are as effective as in-person visits for asthma patients. And, real-time telemedically delivered asthma education may improve quality of life and educational outcomes, as well as enhance symptom management ability for patients with asthma and reduce symptom burden on both patients and their families.
Guided by the preferred reporting items for systematic reviews and meta-analyses, our research team searched four academic databases using terms related to asthma, education, and pediatrics. Articles were peer-reviewed and involved a school-based setting, children and adolescents, a telemedical mechanism for training, and an empirical study design. Data regarding participant background, research methods and purpose, and outcomes were extracted from each. Included studies were also evaluated for methodological rigor.
A Positive Influence
After removing duplicates, 408 papers were initially identified, five of which met inclusion criteria. Three of the five were in rural settings, three studies were randomized, and two were cohort studies. Overall, there was little consistency in the educational materials and types of measurement instruments (eg, questionnaires and data collection tools) used across studies. In addition to clinical and educational outcomes, studies reported on satisfaction, self-management, self-efficacy, asthma knowledge gain, and quality of life (Table). Regarding methodological rigor among the five studies, two were rated as strong, two as moderate, and one as weak.
Results of real-time telemedically delivered asthma education to improve quality of life, enhance symptom management ability, and reduce symptom burden were positive or non-significant. No study indicated negative effects or worsening of symptoms due to instruction via telemedicine. Also, there was mixed support among studies evaluating airway inflammation improvement, symptom-free days, symptom control, spirometry, medication use, visits to physicians or an emergency department, and participant quality of life. While limited, results across the studies indicate that patient education can positively influence symptom burden, participant self-management behaviors, asthma knowledge, and caregiver or parent quality of life. However, we recommend further validation of intervention methods and tools as well as outcome measurement consistency with future studies related to telemedical asthma education.
Further benefits of telemedically delivered asthma education may be realized with more consistent testing and evaluation. Members of our research team are in the process of validating a standardized set of materials and procedures that will aid in standardizing asthma-based education and the measurement of outcomes, thereby making it easier to implement a solution that will benefit children with asthma and their families.
Telemedical Asthma Education and Health Care Outcomes for School-Age Children: A Systematic Review https://www.jaci-inpractice.org/article/S2213-2198(20)30154-9/abstract