Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity,JAMA Pediatrics

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Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity
JAMA Pediatrics ( IF 24.7 ) Pub Date : 2018-03-05 , DOI: 10.1001/jamapediatrics.2017.4938
Jill S. Halterman ₁ , Maria Fagnano ₁ , Reynaldo S. Tajon ₁ , Paul Tremblay ₁ , Hongyue Wang ₂ , Arlene Butz ₃ , Tamara T. Perry ₄ , Kenneth M. McConnochie ₁

Affiliation

Importance Poor adherence to recommended preventive asthma medications is common, leading to preventable morbidity. We developed the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) program to build on school-based supervised therapy programs by incorporating telemedicine at school to overcome barriers to preventive asthma care. Objective To evaluate the effect of the SB-TEAM program on asthma morbidity among urban children with persistent asthma. Design, Setting, and Participants In this randomized clinical trial, children with persistent asthma aged 3 to 10 years in the Rochester City School District in Rochester, New York, were stratified by preventive medication use at baseline and randomly assigned to the SB-TEAM program or enhanced usual care for 1 school year. Participants were enrolled at the beginning of the school year (2012-2016), and outcomes were assessed through the end of the school year. Data were analyzed between May 2017 and November 2017 using multivariable modified intention-to-treat analyses. Interventions Supervised administration of preventive asthma medication at school as well as 3 school-based telemedicine visits to ensure appropriate assessment, preventive medication prescription, and follow-up care. The school site component of the telemedicine visit was completed by telemedicine assistants, who obtained history and examination data. 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. Preventive medication prescriptions were sent to pharmacies that deliver to schools for supervised daily administration. Main Outcomes and Measures The primary outcome was the mean number of symptom-free days per 2 weeks, assessed by bimonthly blinded interviews. Results Of the 400 enrolled children, 247 (61.8%) were male and 230 (57.5%) were African American, and the mean (SD) age was 7.8 (1.7) years. Demographic characteristics and asthma severity in the 2 groups were similar at baseline. Among children in the SB-TEAM group, 196 (98.0%) had 1 or more telemedicine visits, and 165 (82.5%) received supervised therapy through school. We found that children in the SB-TEAM group had more symptom-free days per 2 weeks postintervention compared with children in the enhanced usual care group (11.6 vs 10.97; difference, 0.69; 95% CI, 0.15-1.22; P = .01), with the largest difference observed at the final follow-up (difference, 0.85; 95% CI, 0.10-1.59). In addition, children in the SB-TEAM group were less likely to have an emergency department visit or hospitalization for asthma (7% vs 15%; odds ratio, 0.52; 95% CI, 0.32-0.84). Conclusions and Relevance The SB-TEAM intervention significantly improved symptoms and reduced health care utilization among urban children with persistent asthma. This program could serve as a model for sustainable asthma care among school-aged children. Trial Registration clinicaltrials.gov Identifier: NCT01650844

中文翻译：

学校远程医疗增强哮喘管理 (SB-TEAM) 计划对哮喘发病率的影响

重要性对推荐的预防性哮喘药物的依从性差很常见，导致可预防的发病率。我们开发了基于学校的远程医疗增强哮喘管理 (SB-TEAM) 计划，通过在学校纳入远程医疗以克服预防性哮喘护理的障碍，以基于学校的监督治疗计划为基础。目的评价SB-TEAM项目对城市持续性哮喘儿童哮喘发病率的影响。设计、设置和参与者在这项随机临床试验中，纽约罗彻斯特市学区的 3 至 10 岁持续性哮喘儿童根据基线预防性药物使用情况进行分层，并随机分配到 SB-TEAM 计划或加强 1 个学年的常规护理。参与者在学年开始时（2012-2016 年）入学，并在学年结束时评估结果。使用多变量改良意向治疗分析对 2017 年 5 月至 2017 年 11 月期间的数据进行了分析。干预监督学校预防性哮喘药物的管理以及 3 次基于学校的远程医疗访问，以确保适当的评估、预防性药物处方和后续护理。远程医疗访问的学校站点部分由远程医疗助理完成，他们获得了病史和检查数据。这些数据存储在安全的虚拟候诊室中，然后由初级保健临床医生查看，后者完成评估并通过视频会议或电话与护理人员沟通。预防性药物处方被送到药房，然后送到学校进行日常监督管理。主要结果和测量主要结果是每 2 周无症状天数的平均数，通过双月盲访评估。结果 400 名登记儿童中，男性 247 人（61.8%），非裔美国人 230 人（57.5%），平均（SD）年龄为 7.8（1.7）岁。两组的人口统计学特征和哮喘严重程度在基线时相似。在 SB-TEAM 组的儿童中，196 名 (98.0%) 接受过 1 次或多次远程医疗访问，165 名 (82.5%) 通过学校接受监督治疗。我们发现 SB-TEAM 组的儿童在干预后每 2 周的无症状天数多于加强常规护理组的儿童（11.6 对 10.97；差异，0.69；95% CI，0.15-1.22；P = .01 ), 在最后一次随访时观察到的最大差异（差异，0.85；95% CI，0.10-1.59）。此外，SB-TEAM 组的儿童因哮喘急诊或住院的可能性较小（7% 对 15%；优势比，0.52；95% CI，0.32-0.84）。结论和相关性 SB-TEAM 干预显着改善了患有持续性哮喘的城市儿童的症状并降低了医疗保健的利用率。该计划可以作为学龄儿童可持续哮喘护理的典范。试验注册clinicaltrials.gov 标识符：NCT01650844 0.32-0.84）。结论和相关性 SB-TEAM 干预显着改善了患有持续性哮喘的城市儿童的症状并降低了医疗保健的利用率。该计划可以作为学龄儿童可持续哮喘护理的典范。试验注册clinicaltrials.gov 标识符：NCT01650844 0.32-0.84）。结论和相关性 SB-TEAM 干预显着改善了患有持续性哮喘的城市儿童的症状并降低了医疗保健的利用率。该计划可以作为学龄儿童可持续哮喘护理的典范。试验注册clinicaltrials.gov 标识符：NCT01650844

更新日期：2018-03-05

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