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

To evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma.Design: Randomized trial, with children stratified by smoke exposure in the home and randomized to a schoolbased care group or a usual care control group.

Background Low-income, minority teens have disproportionately high rates of asthma morbidity and are at high-risk for non-adherence to preventive medications. Objective To assess the feasibility and preliminary effectiveness of an innovative school-based asthma program to enhance the delivery of preventive care for 12–15 year olds with persistent asthma. We hypothesized that this intervention would; 1) be feasible and acceptable among this population, and 2) yield reduced asthma morbidity. Design/Methods Subjects/Setting Teens with persistent asthma and a current preventive medication prescription in Rochester, NY. Design Single group pre-post pilot study during the 2009–10 school year. Intervention Teens visited the school nurse daily for 6–8 weeks at the start of the school year to receive directly observed therapy (DOT) of preventive asthma medications; 2–4 weeks following DOT initiation, they received 3 counseling sessions (1 in-home and 2 via telephone) using motivational interviewing (MI) to explore attitudes about asthma management, build motivation for medication adherence, and support transition to independent preventive medication use. Primary Outcome Number of symptom-free days (SFDs)/2 weeks; outcome data were collected 2 months after baseline and at the end of school year. Results We enrolled 30 teens; 28 participated in the intervention. All teens initiated a trial of school-based DOT. All in-home MI visits were completed successfully, and 89% completed both follow-up sessions. Teens experienced an overall reduction of symptoms with more SFDs/2 weeks from baseline to 2-month and final (end of school year) assessments (8.71 vs. 10.79 vs. 12.89, respectively, p=.046 and .004). Teens also reported fewer days with symptoms, less activity limitation, and less rescue medication use (all p<.05). Exhaled nitric oxide levels decreased (p=.012), suggesting less airway inflammation. At the final assessment, teens reported significantly higher motivation to take their preventive medication every day (p=.043). At the end of the study, 79% of teens stated that they were better at managing asthma on their own, and 93% said they would participate in a similar program again. Conclusions This pilot study provides preliminary evidence of the feasibility and effectiveness of a novel school-based intervention to promote independence in asthma management and improve asthma outcomes in urban teens.

Objective To test the feasibility and preliminary effectiveness of the SB-PACT program, which includes directly observed therapy of preventive asthma medications in school facilitated by web-based technology for systematic symptom screening, electronic report generation, and medication authorization from providers. Study design We conducted a pilot randomized trial of SB-PACT vs. usual care with 100 children (ages 3-10yrs) from 19 inner-city schools in Rochester, NY. Outcomes were assessed longitudinally by blinded interviewers. Analyses included bivariate statistics and linear regression models, adjusting for baseline symptoms. Results 99 subjects had data for analysis. We screened all children using the web-based system, and 44/49 treatment children received directly observed therapy as authorized by their providers. Treatment children received preventive medications 98% of the time they were in school. Over the school year, children in the treatment group experienced nearly 1 additional symptom-free day/two weeks vs. usual care (11.33 vs. 10.40,p=.13). Treatment children also experienced fewer symptom nights (1.68 vs. 2.20,p=.02), days requiring rescue medications (1.66 vs. 2.44,p=.01) and days absent from school due to asthma (.37 vs. .85,p=.03) compared with usual care. Further, treatment children had a greater decrease in exhaled nitric oxide (−9.62 vs. −.39,p=.03), suggesting reduction in airway inflammation. Conclusion The SB-PACT intervention demonstrated feasibility and improved outcomes across multiple measures in this pilot study. Future work will focus on further integration of preventive care delivery across community and primary care systems.

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