Retrospective assessment of a collaborative digital asthma program for Medicaid-enrolled children in southwest Detroit: reductions in short-acting beta-agonist (SABA) medication use

Outcomes and Recommendations From Telehealth Asthma Clinics in Underserved Schools

BACKGROUND AND OBJECTIVE

Individuals from historically marginalized populations face structural and social determinants of health that create barriers to receiving specialty asthma care. School-based specialist care delivered via telehealth offers a potential solution for children with uncontrolled asthma. This study evaluated the reach, implementation, and effectiveness of school-based telehealth asthma clinics led by pediatric pulmonologists in historically marginalized neighborhoods.

METHODS

Patients completed at least one visit with an asthma specialist via telehealth, including assessments of asthma control, lung function, exacerbations, and healthcare utilization. Descriptive analyses and means comparison tests of electronic health record data were conducted to examine outcomes.

RESULTS

Asthma specialists provided telehealth care for 54 patients (Mage = 12.23, SD = 3.71) between May 2019 and May 2023. The clinics reached a high percentage of individuals from historically marginalized populations (90.7% Black or African American, 92.6% public insurance) who had not previously received specialty asthma care (51.9%). Twenty-three patients (42.6%) were seen more than once in the school-based telehealth asthma clinics (M = 3.43 visits, SD = 1.53). Asthma control significantly improved for those patients, t(19) = 2.61, p = 0.017, Cohen's d = 0.58, with 30% improving from poorly controlled to well-controlled. Exacerbations and healthcare utilization decreased.

CONCLUSIONS

Specialist-delivered, school-based telehealth asthma clinics effectively reached patients from historically marginalized backgrounds and improved clinical outcomes. This school-based telehealth model can be applied across settings to reach patients who might not otherwise have access to specialty care.

Clinically-enhanced digital health program for respiratory care associated with better medication use and retention

Digital health platforms for asthma self-management have demonstrated promise in improving clinical and quality of life outcomes. However, few studies have examined such an approach in a real-world, fully remote setting. As such, we evaluated the benefit of an evidence-based digital self-management platform for asthma-both on its own and when integrated into an established virtual clinical service. We compared six-month outcomes of a digital self-management program plus virtual clinical oversight, called a therapeutic resource center, (DP + TRC) with a digital self-management-only (DP) program in patients with uncontrolled asthma. The DP included electronic medication sensors that captured the date and time of both short-acting beta agonist (SABA) and controller medication usage. The TRC included remote care oversight to promote inhaler adherence and address symptom worsening. SABA usage, controller adherence and program retention were assessed retrospectively using regression models controlling for age, enrollment year, controller/SABA use, and baseline asthma control status.18,584 DP patients (mean age (SD): 33 (14.6) yrs; 89.9% uncontrolled asthma) and 3440 DP + TRC patients (mean age (SD): 43.7 (15.6) yrs); 48.6% uncontrolled) were assessed. We observed significantly better six-month program retention (55% vs. 41%, p < 0.001) and controller adherence (54% vs. 45%, p < 0.001), but no statistically significant differences in mean SABA use (0.76 vs. 0.87 mean puffs/day; p = 0.158) for the DP + TRC vs. DP groups, respectively. From baseline to six months, both groups had similar reductions in mean daily SABA use (both p < 0.001) and improvements in the percent of SABA-free days (both p < 0.001). The proportion of patients with ≥80% controller adherence declined in both groups, but a larger relative decline was noted in the DP vs. DP + TRC group. A digital self-management platform for asthma management combined with virtual clinical oversight may offer a scalable solution that not only achieves reduced SABA use, but also promotes medication adherence and increases program retention.

Health disparities in allergic diseases

PURPOSE OF REVIEW

Healthcare disparities impact prevalence, diagnosis, and management of allergic disease. The purpose of this review is to highlight the most recent evidence of healthcare disparities in allergic conditions to provide healthcare providers with better understanding of the factors contributing to disparities and to provide potential management approaches to address them. This review comes at a time in medicine where it is well documented that disparities exist, but we seek to answer the Why , How and What to do next?

RECENT FINDINGS

The literature highlights the socioeconomic factors at play including race/ ethnicity, neighborhood, insurance status and income. Management strategies have been implemented with the hopes of mitigating the disparate health outcomes including utilization of school-based health, distribution of educational tools and more inclusive research recruitment.

SUMMARY

The studies included describe the associations between upstream structural and social factors with downstream outcomes and provide ideas that can be recreated at other institutions of how to address them. Focus on research and strategies to mitigate healthcare disparities and improve diverse research participant pools are necessary to improve patient outcomes in the future.