Teaching through telemedicine: A systematic review of education-focused asthma interventions (Preprint)
Authors: Culmer Nathan , Smith Todd , Stager Catanya , Wright Andrea , Burgess Karen , Johns Samantha , Watt Mykaela , Desch Madison 
Published: June 2019

BACKGROUND

Asthma affects nearly six million children in the United States, with annual school absences totaling 13.8 million days and additional health expenses of $800/year. With limited access to health care in remote locations and underserved communities, telemedicine in a school-based setting involving partnerships between an asthmatic child and health care provider can provide patients with the opportunity to better manage chronic conditions, communicate among partners, and collaborate for solutions.

OBJECTIVE

The aim of this systematic review is to examine the findings from partnerships involving school-based telemedicine studies using live video streaming to support clinical and educational outcomes for patient-centered care.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched the peer-reviewed literature with terms related to asthma, education and pediatrics and found 408 unduplicated, relevant articles. A determination to include or exclude each abstract was independently made through reviews by at least two researchers. All conflicts were resolved through a consensus by the two lead authors, resulting in five articles. We then methodically extracted data from these five articles related to a) participant background, b) research methods and purpose, and (c) outcomes (educational, self-management, clinical, quality of life (QOL), and satisfaction). We also used the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool to better understand the methodological rigor of each study.

RESULTS

Our results support telemedicine in a school-based setting as an effective means of empowering asthmatic children and their families to better manage their asthma and thereby improve quality of life. All projects utilized telemedicine technology and live two-way video streaming. We found a variety of educational and curricular tools used to deliver the sessions, with each study reporting generally positive results in terms of clinical outcomes (such as symptom-free days [SFDs] and health care utilization), learning, self-management of asthma, satisfaction with the intervention, and certain aspects of QOL, but not in terms of self-efficacy. Regarding the methodological rigor of the five studies, we rated two articles as strong, two as moderate, and one as weak.

CONCLUSIONS

After a review of these five studies, we believe that real-time telemedically delivered asthma education has great potential to improve QOL, enhance symptom management ability, and reduce symptom burden on asthma patients, though the results were mixed across the studies. In terms of clinical outcomes, most, but not all, studies found statistically significant improvements in terms of SFDs, symptom control, peak flow rates, and visits to physicians or an ED. Additionally, we found promising results that patient education can, under proper circumstances, positively influence symptom burden. However, further validation of the methods and tools used for these interventions is both merited and prudent.