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Sherman J, Zalzal H, Bower K. Equitable Care for Children With a Tracheostomy: Addressing Challenges and Seeking Systemic Solutions. Health Expect 2024; 27:e14158. [PMID: 39056161 PMCID: PMC11272989 DOI: 10.1111/hex.14158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Children with medical complexity (CMC) often face significant barriers to accessing care, obtaining appropriate insurance coverage for medical devices, technology, supplies, home nursing and social services. These challenges, when viewed through the lens of social determinants of health, highlight concerns about healthcare inequity. These inequities can impact CMC by limiting access to follow-up appointments, leading to disproportionate use of emergency department services, restricting support services, reducing the quality of medical products and increasing the likelihood of adverse events. Addressing these concerns requires comprehensive policy changes at both state and federal levels. Achieving successful collaborations between states and federal agencies is particularly challenging and may take months or even years to accomplish. OBJECTIVES Through an exploratory qualitative approach, this study facilitates a nuanced inquiry into the experiences and systemic challenges encountered by medical professionals and primary caregivers managing CMC who require a paediatric tracheostomy. METHODS Qualitative interviews were conducted with 17 health professionals and primary caregivers residing in the United States. A thematic analysis was used to analyse the transcribed interview data. RESULTS Using exploratory thematic analysis, we identified challenges and opportunities for improvement regarding (a) access to health insurance, (b) procurement of essential medical supplies, (c) logistical constraints and (d) identifying interim solutions. CONCLUSION Building on our findings, we discuss how socioecological factors impact health and quality of life of CMC and families. Additionally, we address the growing gap in quality of care through a comprehensive approach that considers patient needs, regulatory frameworks and affordability. PATIENT OR PUBLIC CONTRIBUTION Medical practitioners and healthcare professionals were actively involved in the development, production and implementation of the research project. These individuals were given the opportunity to review their statements and review the manuscript before publishing. While caregivers did not engage in member checking, each provided their consent before data collection.
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Affiliation(s)
- Jules Sherman
- Children's National Hospital, Innovation VenturesWashingtonDCUSA
| | - Habib Zalzal
- Division of OtolaryngologyChildren's National HospitalWashingtonDCUSA
| | - Kyle Bower
- Department of Human Development and Family SciencesThe University of GeorgiaAthensGeorgiaUSA
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Rangachari P, Parvez I, LaFontaine AA, Mejias C, Thawer F, Chen J, Pathak N, Mehta R. Effect of Disease Severity, Age of Child, and Clinic No-Shows on Unscheduled Healthcare Use for Childhood Asthma at an Academic Medical Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1508. [PMID: 36674266 PMCID: PMC9864702 DOI: 10.3390/ijerph20021508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 06/10/2023]
Abstract
This study examines the influence of various individual demographic and risk factors on the use of unscheduled healthcare (emergency and inpatient visits) among pediatric outpatients with asthma over three retrospective timeframes (12, 18, and 24 months) at an academic health center. Out of a total of 410 children who visited an academic medical center for asthma outpatient care between 2019 and 2020, 105 (26%) were users of unscheduled healthcare for childhood asthma over the prior 12 months, 131 (32%) over the prior 18 months, and 147 (36%) over the prior 24 months. multiple logistic regression (MLR) analysis of the effect of individual risk factors revealed that asthma severity, age of child, and clinic no-shows were statistically significant predictors of unscheduled healthcare use for childhood asthma. Children with higher levels of asthma severity were significantly more likely to use unscheduled healthcare (compared to children with lower levels of asthma severity) across all three timeframes. Likewise, children with three to four clinic no-shows were significantly more likely to use unscheduled healthcare compared to children with zero clinic no-shows in the short term (12 and 18 months). In contrast, older children were significantly less likely to use unscheduled healthcare use compared to younger children in the longer term (24 months). By virtue of its scope and design, this study provides a foundation for addressing a need identified in the literature for short- and long-term strategies for improving supported self-management and reducing unscheduled healthcare use for childhood asthma at the patient, provider, and organizational levels, e.g., (1) implementing telehealth services for asthma outpatient care to reduce clinic no-shows across all levels of asthma severity in the short term; (2) developing a provider-patient partnership to enable patient-centered asthma control among younger children with higher asthma severity in the long term; and (3) identifying hospital-community linkages to address social risk factors influencing clinic no-shows and unscheduled healthcare use among younger children with higher asthma severity in the long term.
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Affiliation(s)
- Pavani Rangachari
- Department of Population Health & Leadership, School of Health Sciences, University of New Haven, West Haven, CT 06516, USA
| | - Imran Parvez
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | | | | | - Fahim Thawer
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Jie Chen
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Niharika Pathak
- Department of Population Health & Leadership, School of Health Sciences, University of New Haven, West Haven, CT 06516, USA
| | - Renuka Mehta
- Division of Critical Care Medicine, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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Kameda-Smith MM, Pond GR, Seow H. Rurality index score and pediatric neuro-oncological outcome in Ontario. J Neurosurg Pediatr 2023; 31:275-281. [PMID: 36640100 DOI: 10.3171/2022.12.peds22446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/09/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Rapid access to neurosurgical decisions and definitive management are vital for the outcome of neurocritical patients. There are unique challenges associated with the provision of services required to maintain critical infrastructure for rural citizens. Given that a relationship between rurality, marginalization, and health outcomes has been identified as associated with higher mortality rates and higher rates of many diseases, the authors studied whether worse clinical outcomes were associated with rurality in pediatric neuro-oncological disease. METHODS Using linked administrative databases, the authors retrospectively analyzed a population-based cohort of patients diagnosed with a pediatric brain tumor between 1996 and 2017 in Ontario, Canada. The main variable of interest was the Rurality Index for Ontario (RIO; larger value denotes more rural); the main outcome was survival, while controlling for surgery and tumor type. RESULTS Of the 1428 patients included, 53.9% were male. Overall survival of all the children (controlling for surgery and tumor type) at 1, 5, and 10 years was 84.7%, 65.1%, and 58.4%, respectively. A total of 11.5% were classified as living in a rural area of Ontario. The distance to the nearest pediatric neurosurgical hospital ranged from 25.6 to 167.4 km. The RIO score was 0 in 38.7% of children, and the majority of patients had a RIO score < 40. A higher RIO score was not a significant factor (continuous p = 0.12/ordinal p = 0.18) associated with length of follow-up, indicating that rurality was not significantly linked to compliance with clinical follow-up. CONCLUSIONS Rurality of the region in which pediatric neuro-oncological patients reside was not associated with patient outcome (HR 0.83, p = 0.39).
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Affiliation(s)
| | | | - Hsien Seow
- 3Oncology, McMaster University, Hamilton, Ontario, Canada
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Justvig SP, Haynes L, Karpowicz K, Unsworth F, Petrosino S, Peltz A, Jones BL, Hickingbotham M, Cox J, Wu AC, Holder-Niles FF. The Role of Social Determinants of Health in the Use of Telemedicine for Asthma in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2543-2549. [PMID: 35863670 DOI: 10.1016/j.jaip.2022.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
Asthma is the most common chronic health condition among children in the United States. The adverse impacts of social determinants of health often manifest in unmet health-related social needs, potentially contributing to worse asthma outcomes. With the onset and rapid spread of coronavirus disease 2019 (COVID-19) and the identification of asthma as a potential risk factor for more severe disease, our asthma program quickly pivoted to a remote-access telemedicine asthma population management platform to best meet the needs of our most at-risk patients. Our practice provides care to a large proportion of Black and Latino/a/e children in urban areas insured by the State Medicaid Program and impacted by unmet social needs. As we pivoted to telemedicine, we consistently reached a greater number of patients and families than prepandemic and observed decreased emergency department visits and hospitalizations. About 1 in 5 families received resource touch points spanning categories of transportation, food and supplies, clothing, utilities, and rent. Overall, families reported positive experiences with telemedicine, including the ability to connect remotely with our social work and resource teams. Telemedicine may be an effective strategy for addressing both the medical and the social needs of children with asthma at risk for worse outcomes.
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Affiliation(s)
- Sarah P Justvig
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Linda Haynes
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Kristin Karpowicz
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Fiona Unsworth
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Sheila Petrosino
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Alon Peltz
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Bridgette L Jones
- Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Madison Hickingbotham
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Joanne Cox
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Ann Chen Wu
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.
| | - Faye F Holder-Niles
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass.
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Fossati A, Challier C, Dalhoumi AA, Rose J, Robinson A, Perisson C, Galode F, Luaces B, Fayon M. Telehome Monitoring of Symptoms and Lung Function in Children with Asthma. Healthcare (Basel) 2022; 10:healthcare10061131. [PMID: 35742182 PMCID: PMC9222427 DOI: 10.3390/healthcare10061131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The ability to perceive bronchial obstruction is variable in asthma. This is one of the main causes of inaccurate asthma control assessment, on which therapeutic strategies are based. Objective: Primary: To evaluate the ability of physicians to characterize the bronchial obstruction perception profile in asthmatic children using a clinical and spiro-metric telemonitoring device. Secondary: To evaluate its impact on asthma management (control, treatment, respiratory function variability) and the acceptability of this telemonitoring system. Methods: 26 asthmatic children aged 6−18 years equipped with a portable spirometer and a smartphone application were home-monitored remotely for 3 months. Clinical and spiro-metric data were automatically transmitted to a secure internet platform. By analyzing these data, three physicians blindly and independently classified the patients according to their perception profile. The impact of telemonitoring on the quantitative data was assessed at the beginning (T0) and end (T3 months) of telemonitoring, using matched statistical tests. Results: Patients could initially be classified according to their perception profile, with a concordance between the three observers of 64% (kappa coefficient: 0.55, 95%CI [0.39; 0.71]). After discussion among the observers, consensus was reached for all patients but one. There was a significant >40% decrease in FEV1 and PEF variability, with good acceptance of the device. Conclusions: Clinical and spiro-metric tele-home monitoring is applicable and can help define the perception profile of bronchial obstruction in asthmatic children. The device was generally well accepted.
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Affiliation(s)
- Audrey Fossati
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Pediatrics Department, Pediatric Pulmonology, CEDEX, 33076 Bordeaux, France; (C.C.); (F.G.); (M.F.)
- Correspondence:
| | - Caroline Challier
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Pediatrics Department, Pediatric Pulmonology, CEDEX, 33076 Bordeaux, France; (C.C.); (F.G.); (M.F.)
| | - Aman Allah Dalhoumi
- Centre Hospitalier d’Agen-Nérac, Pediatrics Department, 47000 Agen, France; (A.A.D.); (B.L.)
| | - Javier Rose
- Paediatric Department, Seychelles Hospital, Victoria P.O. Box 52, Seychelles;
| | - Annick Robinson
- Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Department of Child Health, Teaching Hospital, Antananarivo 3GVF+76F, Madagascar;
| | - Caroline Perisson
- Centre Hospitalier Universitaire Réunion Sud, Service de Pédiatrie, 97410 Saint Pierre, France;
| | - François Galode
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Pediatrics Department, Pediatric Pulmonology, CEDEX, 33076 Bordeaux, France; (C.C.); (F.G.); (M.F.)
| | - Baptiste Luaces
- Centre Hospitalier d’Agen-Nérac, Pediatrics Department, 47000 Agen, France; (A.A.D.); (B.L.)
| | - Michael Fayon
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Pediatrics Department, Pediatric Pulmonology, CEDEX, 33076 Bordeaux, France; (C.C.); (F.G.); (M.F.)
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Université de Bordeaux, 33000 Bordeaux, France
- Centre d’Investigation Clinique (CIC1401), INSERM, 33076 Bordeaux, France
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Barbosa MT, Sousa CS, Morais-Almeida M. Telemedicine in the Management of Chronic Obstructive Respiratory Diseases: An Overview. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-respiratory-diseases] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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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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MacGeorge CA, King K, Andrews AL, Sterba K, Johnson E, Brinton DL, Teufel RJ, Kruis R, Ford D. School nurse perception of asthma care in school-based telehealth. J Asthma 2021; 59:1248-1255. [PMID: 33730979 DOI: 10.1080/02770903.2021.1904978] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE School-based telehealth (SBTH) offers an opportunity to overcome traditional barriers to providing comprehensive asthma care for children. Guided by an implementation science framework considering factors internal and external to the school setting, we characterized barriers and facilitators to asthma care within an existing SBTH program available in over 50 under-resourced South Carolina schools. METHODS This cross-sectional study assessed barriers and facilitators to SBTH asthma care delivery using web-based surveys of school nurses, specifically addressing school implementation of telehealth methods. Surveys evaluated practices and nurse and school-specific factors related to telehealth implementation including perceived barriers, organizational readiness and self-efficacy. Utilizers were schools who completed 1-10 average visits per month while non-utilizers completed less than 1 average visit per month. Descriptive statistics were performed to characterize perceptions in utilizers versus non-utilizers. RESULTS Of 53 surveys distributed, 36 were completed (68% response rate). Commonly cited barriers included inadequate time due to competing tasks in both utilizers (65%) and non-utilizers (74%) as well as lack of caregiver involvement in care planning (94% of utilizers and 84% of non-utilizers). Of those utilizing specific, relevant telehealth services, schools scored high in perceptions of organizational readiness (n = 24, mean: 24.5/30), self-efficacy (n = 26, mean: 3.6/5) and comfort with identifying students eligible for SBTH (n = 26, mean: 3.5/5). CONCLUSIONS We identified inadequate nurse time and challenges engaging caregivers as key barriers to implementation of a school-based telehealth asthma program providing care to an under-resourced population. Addressing these barriers when expanding telehealth services may promote utilization of telehealth.
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Affiliation(s)
| | - Kathryn King
- Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Annie L Andrews
- Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine Sterba
- Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Emily Johnson
- Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel L Brinton
- Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Ronald J Teufel
- Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Ryan Kruis
- Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Center for Telehealth, Medical University of South Carolina, Charleston, SC, USA
| | - Dee Ford
- Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
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Davies B, Kenia P, Nagakumar P, Gupta A. Paediatric and adolescent asthma: A narrative review of telemedicine and emerging technologies for the post-COVID-19 era. Clin Exp Allergy 2021; 51:393-401. [PMID: 33527625 PMCID: PMC8013619 DOI: 10.1111/cea.13836] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/22/2020] [Accepted: 01/16/2021] [Indexed: 01/25/2023]
Abstract
Children and young people with asthma need regular monitoring to maintain good asthma control, prevent asthma attacks and manage comorbidities. The COVID‐19 pandemic has resulted in healthcare professionals making fundamental changes to the way healthcare is delivered and for patients and families adapting to these changes. Comprehensive remotely delivered, technology‐based healthcare, closer to the patients home (reducing hospital footfall and possibly reducing carbon footprint) is likely to be one of the important collateral effects of the pandemic. Telemedicine is anticipated to impact everyone involved in healthcare ‐ providers and patients alike. It is going to bring changes to organization, work areas and work culture in healthcare. Healthcare providers, policymakers and those accessing healthcare services will experience the impact of technology‐based healthcare delivery. Telemedicine can play an exciting role in the management of childhood asthma by delivering high‐quality care closer to the child's home. However, unlike adults, children still need to be accompanied by their carers for virtual care. Policymakers will need to take into account potential additional costs as well as the legal, ethical and cultural implications of large scale use of telemedicine. In this narrative review, we review evidence regarding the role of telemedicine and related emerging technologies in paediatric and adolescent asthma. Although there are gaps in the current knowledge, there is evidence demonstrating the important role of telemedicine in management of childhood and adolescent asthma. However, there is an urgent need for healthcare researchers and policymakers to focus on improving the technologies and address the disparities in accessing novel technology‐based management strategies to improve asthma care.
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Affiliation(s)
- Benjamin Davies
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
| | - Priti Kenia
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Prasad Nagakumar
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
| | - Atul Gupta
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
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