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Perry TT, Marko A, Russell AF, Cooke AT, Bingemann TA, Ross KR, Young MC. How Schools Can Help Address Social Determinants of Health in Asthma Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:316-326. [PMID: 37839577 DOI: 10.1016/j.jaip.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
Schools are in a unique position to address social determinants of health (SDOHs) in pediatric asthma management because of their potential to provide resources and facilitate collaboration with health care providers and services for children at risk within their community. SDOHs include economic factors, educational attainment and health literacy, neighborhood factors and the built environment, social and community aspects including discrimination and racism, and health care access and quality. These factors have a significant impact on asthma health in children, and certain populations such as minoritzed populations and those living in high-poverty environments have been shown to be at greater risk for adverse effects of SDOHs on asthma outcomes. School-based asthma programs address several SDOHs including health literacy, the built environment, and health care quality and access and have been shown to improve asthma outcomes. Key components include connection between the school and the health care team, self-management education, and directly observed therapy. School nurses play a key role in directing and managing effective programs because they can evaluate and support a student's health while considering the effect of SDOHs at interpersonal, institutional, community, and policy levels.
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Affiliation(s)
- Tamara T Perry
- Division of Allergy and Immunology, College of Medicine, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Angela Marko
- Division of Pediatric Pulmonology and Sleep Medicine, UH Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio.
| | - Anne F Russell
- School of Nursing and Health Sciences, Spring Arbor University, Spring Arbor, Mich; Food Allergy and Anaphylaxis Michigan Association, Ann Arbor, Mich
| | - Abigail T Cooke
- Allergy and Asthma Specialists, Durango, Colo; Colorado State University-Pueblo: Graduate School of Nursing, Pueblo, Colo
| | - Theresa A Bingemann
- Departments of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester School of Medicine, Rochester, NY
| | - Kristie R Ross
- Division of Pediatric Pulmonology and Sleep Medicine, UH Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Michael C Young
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
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Pongdee T, Brunner WM, Kanuga MJ, Sussman JH, Wi CI, Juhn YJ. Rural Health Disparities in Allergy, Asthma, and Immunologic Diseases: The Current State and Future Direction for Clinical Care and Research. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:334-344. [PMID: 38013156 PMCID: PMC11089647 DOI: 10.1016/j.jaip.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/06/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
Rural health disparities are well documented and continue to jeopardize the long-term health and wellness for the millions of individuals who live in rural America. The disparities observed between urban and rural residents encompass numerous morbidity and mortality measures for several chronic diseases and have been referred to as the "rural mortality penalty." Although the unmet health needs of rural communities are widely acknowledged, little is known about rural health disparities in allergies, asthma, and immunologic diseases. Furthermore, the intersection between rural health disparities and social determinants of health has not been fully explored. To achieve a more complete understanding of the factors that perpetuate rural health disparities, greater research efforts followed by improved practice and policy are needed that account for the complex social context within rural communities rather than a general comparison between urban and rural environments or focusing on biomedical factors. Moreover, research efforts must prioritize community inclusion throughout rural areas through meaningful engagement of stakeholders in both clinical care and research. In this review, we examine the scope of health disparities in the rural United States and the impact of social determinants of health. We then detail the current state of rural health disparities in the field of allergy, asthma, and immunology. To close, we offer future considerations to address knowledge gaps and unmet needs for both clinical care and research in addressing rural health disparities.
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Affiliation(s)
- Thanai Pongdee
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn.
| | - Wendy M Brunner
- Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, Cooperstown, NY
| | - Mansi J Kanuga
- Division of Allergic Diseases, Mayo Clinic Health System, Red Wing, Minn
| | | | - Chung-Il Wi
- Precision Population Science Lab, Mayo Clinic, Rochester, Minn; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
| | - Young J Juhn
- Precision Population Science Lab, Mayo Clinic, Rochester, Minn; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Office of Mayo Clinic Health System Research, Mayo Clinic Health System, Rochester, Minn.
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Ramsey RR, Noser A, McDowell KM, Sherman SN, Hommel KA, Guilbert TW. Children with uncontrolled asthma from economically disadvantaged neighborhoods: Needs assessment and the development of a school-based telehealth and electronic inhaler monitoring system. Pediatr Pulmonol 2023; 58:2249-2259. [PMID: 37194988 PMCID: PMC10524439 DOI: 10.1002/ppul.26457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/11/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Children from economically disadvantaged communities often encounter healthcare access barriers, increasing risk for poorly controlled asthma and subsequent healthcare utilization. This highlights the need to identify novel intervention strategies for these families. OBJECTIVE To better understand the needs and treatment preferences for asthma management in children from economically disadvantaged communities and to develop a novel asthma management intervention based on an initial needs assessment and stakeholder feedback. METHODS Semistructured interviews and focus groups were conducted with 19 children (10-17 years old) with uncontrolled asthma and their caregivers, 14 school nurses, 8 primary care physicians, and three school resource coordinators from economically disadvantaged communities. Interviews and focus groups were audio-taped and transcribed verbatim and then analyzed thematically to inform intervention development. Using stakeholder input, an intervention was developed for children with uncontrolled asthma and presented to participants for feedback to fully develop a novel intervention. RESULTS The needs assessment resulted in five themes: (1) barriers to quality asthma care, (2) poor communication across care providers, (3) problems identifying and managing symptoms and triggers among families, (4) difficulties with adherence, and (5) stigma. A proposed video-based telehealth intervention was proposed to stakeholders who provided favorable and informative feedback for the final development of the intervention for children with uncontrolled asthma. CONCLUSIONS Stakeholder input and feedback provided information critical to the development of a multicomponent (medical and behavioral) intervention in a school setting that uses technology to facilitate care, collaboration, and communication among key stakeholders to improve asthma management for children from economically disadvantaged neighborhoods.
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Affiliation(s)
- Rachelle R. Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Amy Noser
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Karen M. McDowell
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center
| | | | - Kevin A. Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Theresa W. Guilbert
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center
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Abstract
PURPOSE OF REVIEW School-based asthma management is an important component of pediatric asthma care that has the potential to provide more universal evidence-based asthma care to children and mitigate asthma-related health inequities. The purpose of this review is to highlight relevant developments in school-based asthma management over the past 2 years. RECENT FINDINGS There have been considerable recent scientific advances in school-based asthma management including robust clinical trials of environmental interventions in the classroom setting, school-nurse led interventions, stock albuterol policy changes, school-based telemedicine approaches and innovative methods to engage community stakeholders in research that have pushed the frontiers of school-based asthma care. SUMMARY Recent scientific work in school-based asthma management demonstrates the potential power of schools in providing access to guideline-based asthma care for all children with asthma and in improving their health outcomes. Future work should focus on the evaluation of methods to promote the adoption of school-based asthma management strategies in real-world practice and support evidence-based policy change and strategic partnerships to improve asthma health outcomes and produce meaningful public health impact for diverse children and families.
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Affiliation(s)
- Ashley A. Lowe
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
- Asthma & Airway Disease Research Center, University of Arizona Health Sciences, University of Arizona, Tucson, Arizona, USA
| | - Ina St Onge
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, UMass Memorial Children’s Medical Center, Worcester, MA, USA
| | - Michelle Trivedi
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, UMass Memorial Children’s Medical Center, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical Center, Worcester, MA, USA
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, UMass Memorial Children’s Medical Center, Worcester, MA, USA
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The Future of Telehealth for Allergic Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2514-2523. [PMID: 36038132 PMCID: PMC9420069 DOI: 10.1016/j.jaip.2022.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
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The Role of Access and Cost-Effectiveness in Managing Asthma: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2109-2116. [PMID: 35525532 PMCID: PMC9353043 DOI: 10.1016/j.jaip.2022.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 03/25/2022] [Accepted: 04/12/2022] [Indexed: 12/21/2022]
Abstract
Background Inconsistent and unequal access to medical care is an issue that predates the COVID19 pandemic, which only worsened the problem. Limited access to care from asthma specialists and other specialists treating comorbid diseases may adversely affect asthma. Objective The purpose of this review is to identify health disparities associated with access to care for asthma, and cost-effectiveness of therapies and interventions addressing this health disparity. Methods A narrative systematic review was undertaken using MeSH searches of English language articles published in CINAHL, Scopus, or PubMed. Results A total of 725 articles were identified. Barriers recognized from the literature included access to diagnostic spirometry, access to specialists, medication formulary restrictions, and issues leading to medical nonadherence. Telemedicine, school-based health care interventions, digital applications, and non–office-based digital spirometry could be used to address these gaps in access to asthma care while potentially being cost-effective. Conclusion With the widespread adoption of telemedicine because of the pandemic, and adoption of other mobile services, we now have potential tools that can increase access to asthma care, which can help address this health care inequity. Evidence is limited, but favorable, that some of these tools may be cost-effective.
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Waibel KH, Perry TT. Telehealth and Allergy Services in Rural and Regional Locations That Lack Specialty Services. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2507-2513.e1. [PMID: 35777652 PMCID: PMC9280446 DOI: 10.1016/j.jaip.2022.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/03/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022]
Abstract
Secondary to the coronavirus disease 2019 pandemic, telehealth quickly peaked as the dominant health care modality and its use still remains high. Although allergists and health care systems adapted quickly to adopt telehealth, its increased use has both highlighted its benefits for patients and allergists and demonstrated known concerns with delivering allergy specialty care to rural and regional patient populations. With increased concentration of both patients and allergists in urban areas, the ability to provide allergy specialty care to the rural and remote population continues to remain a challenge despite the advantages leveraged through telehealth. Herein, we review aspects specific to the rural patient population, tele-allergy outcomes with these patient cohorts, and efforts, both past and present, taken at different levels within the allergy community to promote our specialty through specific telehealth modalities to address and engage the rural and regional patient.
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Abrams EM, Jordan K, Szefler SJ. School Asthma Care During COVID-19: What We Have Learned and What We Are Learning. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:453-459. [PMID: 34848382 PMCID: PMC8626345 DOI: 10.1016/j.jaip.2021.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 02/07/2023]
Abstract
The focus of this article is to review school asthma care during coronavirus disease 2019 (COVID-19). Asthma is listed as a risk factor in some guidelines, although children with asthma appear to not be at increased risk of severe respiratory outcomes compared with children without asthma during the pandemic. Differentiating COVID-19 from allergic disease is very difficult in the school-aged children. For school management, there is firm evidence that masks do not exacerbate underlying lung conditions including asthma, and evidence to date supports that children with asthma can learn in-person at school because they do not appear to be at increased risk of COVID-19 morbidity or mortality. For children and adolescents, the COVID-19 vaccine has been demonstrated to be safe and well tolerated. School asthma management includes remaining on prescribed asthma medications. Asthma management, as with management of all pediatric conditions, must also factor in the impact of adverse social determinants and health disparities. Broadly, the pandemic has also served as a call to resource stewardship and innovation and allowed practitioners to consider how this may impact asthma care moving forward.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Man, Canada.
| | - Kamyron Jordan
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo
| | - Stanley J Szefler
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo
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Zárate RA, Zigler C, Cubbin C, Matsui EC. RETRACTED: Neighborhood-level variability in asthma-related emergency department visits in Central Texas. J Allergy Clin Immunol 2021; 148:1262-1269.e6. [PMID: 34506851 PMCID: PMC8578425 DOI: 10.1016/j.jaci.2021.07.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022]
Abstract
Background: The extent to which asthma-related ED visit incidence rates vary from neighborhood to neighborhood and predictors of neighorbood-level asthma ED visit burden are not well understood. Objective: To describe the census tract-level spatial distribution of asthma-related emergency department visits in Central Texas and identify neighborhood-level characteristics that explain variability in neighborhood-level asthma ED visit rates. Methods: Conditional autoregressive models were used to examine the spatial distribution of asthma-related ED visit incidence rates across Travis County, TX census tracts and to assess the contribution of census tract characteristics to their distribution. Results: There were distinct patterns in ED visit incidence rates at the census tract scale, which were largely unexplained by socioeconomic or selected built environment neighborhood characteristics. Racial and ethnic composition explained 33% of the variability of ED visit incidence rates across census tracts. Spatial patterns and the census tract predictors of ED visit incidence rates differed by racial and ethnic groups. Conclusions: Variability in asthma ED visit incidence rates are apparent at a smaller spatial scales than previously examined. The majority of the variability in census tract-level asthma ED visit rates in Central Texas is not explained by racial and ethnic composition or other neighborhood features. Race/ethnicity-specific estimates of neighborhood ED visit rates may be useful for identifying high burden neighborhoods for specific ethnic/racial groups, which otherwise would go unrecognized. Asthma ED visit rates may vary among neighborhoods; neighborhood-level interventions or moving to a low incidence neighborhood may be effective in reducing asthma disparities and deserve further study.
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Affiliation(s)
- R. A. Zárate
- Department of Population Health, Dell Medical School at the University of Texas at Austin
| | - Corwin Zigler
- Department of Women’s Health, Dell Medical School at the University of Texas at Austin
- Department of Statistics and Data Sciences at the University of Texas at Austin
| | - Catherine Cubbin
- Department of Population Health, Dell Medical School at the University of Texas at Austin
- Steve Hicks School of Social Work, University of Texas at Austin
| | - Elizabeth C. Matsui
- Department of Population Health, Dell Medical School at the University of Texas at Austin
- Steve Hicks School of Social Work, University of Texas at Austin
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin
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Tsao LR, Villanueva SA, Pines DA, Pham MN, Choo EM, Tang MC, Otani IM. Impact of Rapid Transition to Telemedicine-Based Delivery on Allergy/Immunology Care During COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2672-2679.e2. [PMID: 33894393 PMCID: PMC8061180 DOI: 10.1016/j.jaip.2021.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) necessitated wide-scale adoption of telemedicine (TM) and restriction of in-person care. The impacts on allergy/immunology (A/I) care delivery are still being studied. OBJECTIVE To describe the outcomes of rapid transition to TM-based care (video visit followed by in-person visits dedicated to diagnostic and therapeutic procedures when needed) at an academic A/I practice during COVID-19. METHODS Demographic data were compared for patients originally scheduled for in-person visits between March 10, 2020, and April 30, 2020, who completed a video visit instead between March 10, 2020, and June 30, 2020, and those who did not. Appointment completion, diagnoses, and drug allergy and skin testing completion were compared for visits between March 10, 2020, and June 30, 2020, and 1 year prior (March 10, 2019-June 30, 2019). RESULTS Sixty-nine percent (265 of 382) of patients originally scheduled between March 10, 2020, and April 30, 2020, were able to complete video visits. Patients who completed video visits were more likely to be white (52% vs 33%; P < .001), English-speaking (96% vs 89%; P = .01), and privately insured (70% vs 54%; P = .004). With TM-based care compared with in-person care, there were significant decreases in environmental and food skin testing completion rates (91% and 92% in 2019 vs 60% and 64% in 2020, respectively, P < .001). Drug allergy testing completed after internal referral remained low but comparable (51% in 2019 vs 52% in 2020). Transitioning nonprocedural visits to video allowed allergen immunotherapy and biologic injection visits to resume at a volume similar to pre-COVID. No COVID-19 infections resulted from in-clinic exposure. CONCLUSIONS Although transitioning to TM-based care allowed continued A/I care delivery, strategies are needed to achieve higher testing completion rates and ensure video visits do not exacerbate existing health disparities.
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Affiliation(s)
- Lulu R Tsao
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif.
| | | | - David A Pines
- UCSF Adult Allergy/Immunology Clinic, San Francisco, Calif
| | - Michele N Pham
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif
| | - Eugene M Choo
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif
| | - Monica C Tang
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif
| | - Iris M Otani
- UCSF Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco, Calif
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Volerman A, Kan K, Carpenter D, Press VG. Strategies for Improving Inhalation Technique in Children: A Narrative Review. Patient Prefer Adherence 2021; 15:665-675. [PMID: 33824582 PMCID: PMC8018416 DOI: 10.2147/ppa.s267053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
Inhaled medicines are commonly utilized by children for various respiratory conditions and must be used effectively for the medication to reach the airways. Poor inhaler technique contributes to poorly controlled asthma with significant associated morbidity. Given the significant consequences of improper inhaler use in children, the goal of this review is to comprehensively describe existing and potential solutions to improve inhaler technique. Because children move through various settings, including clinical practices, schools, pharmacies, and homes, in their daily routine, there is great opportunity to teach and reinforce proper inhaler technique across settings. Within each setting, in-person and technology-based interventions have shown promise to improve technique. These solutions need to be more broadly adopted to deliver tailored education with support for provider training, team-based care, communication structures, and reimbursement. Such solutions hold the potential to improve inhaler use among children, with potential for decreasing morbidity and costs.
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Affiliation(s)
- Anna Volerman
- University of Chicago, Departments of Medicine and Pediatrics, Chicago, IL, USA
| | - Kristin Kan
- Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Advanced General Pediatrics Division, Department of Pediatrics, Chicago, IL, USA
| | - Delesha Carpenter
- University of North Carolina at Chapel Hill, Division of Pharmaceutical Outcomes and Policy, Chapel Hill, NC, USA
| | - Valerie G Press
- University of Chicago, Departments of Medicine and Pediatrics, Chicago, IL, USA
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Ronca V, Giorgi A, Rossi D, Di Florio A, Di Flumeri G, Aricò P, Sciaraffa N, Vozzi A, Tamborra L, Simonetti I, Borghini G. A Video-Based Technique for Heart Rate and Eye Blinks Rate Estimation: A Potential Solution for Telemonitoring and Remote Healthcare. SENSORS 2021; 21:s21051607. [PMID: 33668921 PMCID: PMC7956514 DOI: 10.3390/s21051607] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/12/2021] [Accepted: 02/20/2021] [Indexed: 11/16/2022]
Abstract
Current telemedicine and remote healthcare applications foresee different interactions between the doctor and the patient relying on the use of commercial and medical wearable sensors and internet-based video conferencing platforms. Nevertheless, the existing applications necessarily require a contact between the patient and sensors for an objective evaluation of the patient’s state. The proposed study explored an innovative video-based solution for monitoring neurophysiological parameters of potential patients and assessing their mental state. In particular, we investigated the possibility to estimate the heart rate (HR) and eye blinks rate (EBR) of participants while performing laboratory tasks by mean of facial—video analysis. The objectives of the study were focused on: (i) assessing the effectiveness of the proposed technique in estimating the HR and EBR by comparing them with laboratory sensor-based measures and (ii) assessing the capability of the video—based technique in discriminating between the participant’s resting state (Nominal condition) and their active state (Non-nominal condition). The results demonstrated that the HR and EBR estimated through the facial—video technique or the laboratory equipment did not statistically differ (p > 0.1), and that these neurophysiological parameters allowed to discriminate between the Nominal and Non-nominal states (p < 0.02).
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Affiliation(s)
- Vincenzo Ronca
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University, 00185 Rome, Italy; (A.V.); (L.T.); (I.S.)
- BrainSigns srl, 00185 Rome, Italy; (A.G.); (A.D.F.); (G.D.F.); (P.A.); (N.S.)
- Correspondence: (V.R.); (G.B.); Tel.: +39-06-49910941 (V.R. & G.B.)
| | - Andrea Giorgi
- BrainSigns srl, 00185 Rome, Italy; (A.G.); (A.D.F.); (G.D.F.); (P.A.); (N.S.)
| | - Dario Rossi
- Department of Business and Management, LUISS University, 00197 Rome, Italy;
| | - Antonello Di Florio
- BrainSigns srl, 00185 Rome, Italy; (A.G.); (A.D.F.); (G.D.F.); (P.A.); (N.S.)
| | - Gianluca Di Flumeri
- BrainSigns srl, 00185 Rome, Italy; (A.G.); (A.D.F.); (G.D.F.); (P.A.); (N.S.)
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Pietro Aricò
- BrainSigns srl, 00185 Rome, Italy; (A.G.); (A.D.F.); (G.D.F.); (P.A.); (N.S.)
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Nicolina Sciaraffa
- BrainSigns srl, 00185 Rome, Italy; (A.G.); (A.D.F.); (G.D.F.); (P.A.); (N.S.)
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessia Vozzi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University, 00185 Rome, Italy; (A.V.); (L.T.); (I.S.)
- BrainSigns srl, 00185 Rome, Italy; (A.G.); (A.D.F.); (G.D.F.); (P.A.); (N.S.)
| | - Luca Tamborra
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University, 00185 Rome, Italy; (A.V.); (L.T.); (I.S.)
- People Advisory Services Department, Ernst & Young, 00187 Rome, Italy
| | - Ilaria Simonetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University, 00185 Rome, Italy; (A.V.); (L.T.); (I.S.)
- People Advisory Services Department, Ernst & Young, 00187 Rome, Italy
| | - Gianluca Borghini
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
- Correspondence: (V.R.); (G.B.); Tel.: +39-06-49910941 (V.R. & G.B.)
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Telemedicine in School for Asthma Education. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1919-1920. [PMID: 32499037 DOI: 10.1016/j.jaip.2020.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 11/27/2022]
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Abstract
PURPOSE OF REVIEW Telemedicine, defined as synchronous video visits between a provider and a child with asthma, often takes place in the school setting. This review examines the new electronic sensors for adherence monitoring and studies that used telemedicine in the school setting to improve asthma outcomes. RECENT FINDINGS School-based telemedicine provides an important service to families of school-aged children who have difficulty due to time and distance in planning and keeping in-person appointments with primary or specialty providers. Significant improvements in objective measures of asthma control are inconsistently observed although caregiver and parent quality of life and child self-management behaviors are improved and satisfaction is high. Assessment and outcomes related to adherence are mentioned in studies but results are not often reported. However, it appears that adherence interventions are beneficial while maintained but the effects are not sustained upon intervention discontinuation. SUMMARY The school setting provides a convenient and suitable environment to conduct telemedicine visits between school-aged children and their primary care or specialty provider. Electronic adherence sensors allow review of controller and rescue medication use through a cloud-based dashboard and provides an opportunity for real-time assessment and intervention by providers to improve asthma outcomes.
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Affiliation(s)
- Kathryn V Blake
- Biomedical Research Department, Center for Pharmacogenomics and Translational Research, Nemours Children's Specialty Care, Jacksonville, Florida, USA
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15
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Wu AC, Rehman N, Portnoy J. The Good, the Bad, and the Unknown of Telemedicine in Asthma and Allergy Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:2580-2582. [PMID: 31706487 DOI: 10.1016/j.jaip.2019.08.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/18/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Ann Chen Wu
- Center for Healthcare Research in Pediatrics (CHeRP), Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass.
| | - Narmeen Rehman
- Center for Healthcare Research in Pediatrics (CHeRP), Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Jay Portnoy
- Division of Medical Informatics and Telemedicine, Children's Mercy Hospital, Kansas City, Mo
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16
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Portnoy JM, Pandya A, Waller M, Elliott T. Telemedicine and emerging technologies for health care in allergy/immunology. J Allergy Clin Immunol 2020; 145:445-454. [PMID: 32035604 DOI: 10.1016/j.jaci.2019.12.903] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022]
Abstract
Telemedicine (TM) has become a popular method of accessing medical services between providers and patients and is viewed as a cost-effective alternative to more traditional episodic face-to-face encounters. TM overcomes 2 barriers that patients face when seeking health care: distance and time. It is as effective as in-person visits for outpatient treatment of asthma, and it is a convenient way to provide inpatient consultations for patients when the allergist practices outside of the hospital. TM also has been used to manage patients with asthma in schools. Patients tend to be as satisfied with TM or they prefer TM over in-person visits, but infrequently they do prefer in-person visits. In addition to virtual visits using TM, there are several emerging technologies that are relevant to the practice of allergy/immunology including electronic diaries (eg, symptoms and medication use), wearable technology (eg, to monitor activity and vital signs), remote patient monitoring (eg, environmental exposures and medication adherence) as well as electronic medical records augmented with clinical decision support. We believe that the use of TM, particularly when combined with information technologies such as electronic health records, has the potential to cause a transformational change in the way care is delivered by altering the process of interaction between patient and provider. TM addresses the shortage of allergy specialists in rural and underserved urban communities and facilitates patient access to allergy services. As patients take more control of their health care, use of TM is likely to increase because a large part of the move to adopt TM is driven by patient preference.
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Vallabhan MK, Jimenez EY, McCauley GL, Willyard H, Kong AS. Formative Evaluation for Implementation of a Low Literacy Pictorial Asthma Action Plan Delivered via Telehealth Improves Asthma Control. Am J Med Qual 2020; 36:229-237. [PMID: 32830559 DOI: 10.1177/1062860620946838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Consistently uncontrolled asthma in children is an increasing concern in the United States. The use of asthma action plans with asthma education is inconsistent and may be improved with adaptations for low literacy. The objective of this study was formative evaluation for implementation of the New Mexico Pictorial Asthma Action Plan (NM PicAAP). Quality improvement processes guided NM PicAAP face validation and telehealth direct patient care implementation. The asthma control test was selected to measure asthma control. NM PicAAP was revised for face validity, and training curriculum on its use and telehealth implementation processes were developed. Seven youth received NM PicAAP via telehealth direct care, which increased overall asthma control scores over 1 month. NM PicAAP may be useful and effective for improving asthma care in children via telehealth. Additional testing is needed to assess applicability.
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Affiliation(s)
- Monique K Vallabhan
- University of New Mexico, Albuquerque, NM University of New Mexico Health Sciences Center, Albuquerque, NM Nor-Lea Hospital District, Lovington Student Healthcare Center, Lovington, NM
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18
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Abstract
Pediatric patients with uncontrolled asthma often live in underserved areas such as rural communities where few pediatric asthma specialists exist. There are significant costs associated with acute asthma exacerbations, which are increasingly prevalent in these high-risk populations. Telemedicine is a viable option when addressing barriers in access to care and cost-efficiency. Implementing telemedicine in schools and other local community settings, as well as implementing innovative technology such as smartphone applications, can reduce the burden of asthma; increase patient satisfaction; and, most importantly, improve pediatric asthma outcomes.
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Affiliation(s)
- Tamara T Perry
- Department of Pediatrics, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA; Arkansas Children's Research Institute, 13 Children's Way, Slot 512-13, Little Rock, AR 72202, USA.
| | - Callie A Margiotta
- Arkansas Children's Research Institute, 13 Children's Way, Slot 512-13, Little Rock, AR 72202, USA
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Culmer N, Smith T, Stager C, Wright A, Burgess K, Johns S, Watt M, Desch M. Telemedical Asthma Education and Health Care Outcomes for School-Age Children: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1908-1918. [PMID: 32084596 DOI: 10.1016/j.jaip.2020.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Telemedicine in a school-based setting involving partnerships between a child with asthma and health care provider can provide patients and caregivers with opportunities to better manage chronic conditions, communicate among partners, and collaborate for solutions in convenient locations. OBJECTIVE This systematic review examined outcomes for school-age children with asthma involving asthma-based telemedical education. METHODS Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we searched 4 databases with terms related to asthma, education, and pediatrics. Included articles involved a school-based setting, children and adolescents, a telemedical mechanism for training, empirical study designs, and peer review. We extracted data regarding (a) participant background, (b) research methods and purpose, and (c) outcomes. RESULTS A total of 408 articles were identified. Five met inclusion criteria. Three studies were randomized and 2 were cohort studies. In addition to clinical and educational outcomes, studies reported on satisfaction, self-management, asthma knowledge gain, and quality of life (QOL). We found support for caregiver/parent QOL and participant self-management behaviors. We also found mixed results for participant QOL. Clinical outcomes showed mixed support regarding airway inflammation improvement, medication use improvement, improvements in symptom burden and symptom-free days, and spirometry improvements. CONCLUSIONS Results of real-time telemedically delivered asthma education to improve QOL, enhance symptom management ability, and reduce symptom burden were positive or nonsignificant. No study indicated negative effects due to telemedicine. Limited results indicate that patient education can, under certain circumstances, positively influence asthma burden. Further validation of intervention methods and tools as well as outcome measurement consistency is recommended.
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Affiliation(s)
- Nathan Culmer
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala.
| | - Todd Smith
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
| | - Catanya Stager
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
| | - Andrea Wright
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
| | - Karen Burgess
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
| | - Samantha Johns
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
| | - Mykaela Watt
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
| | - Madison Desch
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Ala
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Kim CH, Lieng MK, Rylee TL, Gee KA, Marcin JP, Melnikow JA. School-Based Telemedicine Interventions for Asthma: A Systematic Review. Acad Pediatr 2020; 20:893-901. [PMID: 32446856 PMCID: PMC7241375 DOI: 10.1016/j.acap.2020.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND School health systems are increasingly investing in telemedicine platforms to address acute and chronic illnesses. Asthma, the most common chronic illness in childhood, is of particular interest given its high burden on school absenteeism. OBJECTIVE Conduct a systematic review evaluating impact of school-based telemedicine programs on improving asthma-related outcomes. DATA SOURCES PubMed, Cochrane CENTRAL, CINAHL, ERIC, PsycINFO, Embase, and Google Scholar. STUDY ELIGIBILITY CRITERIA Original research, including quasi-experimental studies, without restriction on the type of telemedicine. PARTICIPANTS School-aged pediatric patients with asthma and their families. INTERVENTIONS School-based telemedicine. STUDY APPRAISAL AND SYNTHESIS METHODS Two authors independently screened each abstract, conducted full-text review, assessed study quality, and extracted information. A third author resolved disagreements. RESULTS Of 371 articles identified, 7 were included for the review. Outcomes of interest were asthma symptom-free days, asthma symptom frequency, quality of life, health care utilization, school absences, and spirometry. Four of 7 studies reported significant increases in symptom-free days and/or decrease in symptom frequency. Five of 6 reported increases in at least one quality-of-life metric, 2 of 7 reported a decrease in at least 1 health care utilization metric, 1 of 3 showed reductions in school absences, and 1 of 2 reported improvements in spirometry measures. LIMITATIONS Variability in intervention designs and outcome measures make comparisons and quantitative analyses across studies difficult. Only 2 of 7 studies were randomized controlled trials. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS High-quality evidence supporting the use of school-based telemedicine programs to improve patient outcomes is limited. While available evidence suggests benefit, only 2 comparative trials were identified, and the contribution of telemedicine to these studies' results is unclear.
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Affiliation(s)
- Christopher H. Kim
- Department of Pediatrics, University of California Davis Health (CH Kim, MK Lieng, and JP Marcin), Sacramento, Calif,Address correspondence to Christopher H. Kim, MD, MPH, Department of Pediatrics, UC Davis Health, 2516 Stockton Blvd, Sacramento, CA 95817
| | - Monica K. Lieng
- Department of Pediatrics, University of California Davis Health (CH Kim, MK Lieng, and JP Marcin), Sacramento, Calif
| | - Tina L. Rylee
- Betty Irene Moore School of Nursing, University of California Davis (TL Rylee), Sacramento, Calif
| | - Kevin A. Gee
- University of California Davis School of Education (KA Gee)
| | - James P. Marcin
- Department of Pediatrics, University of California Davis Health (CH Kim, MK Lieng, and JP Marcin), Sacramento, Calif
| | - Joy A. Melnikow
- Department of Family and Community Medicine (JA Melnikow), Sacramento, Calif
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