A virtual asthma clinic for children: fewer routine outpatient visits, same asthma control

Abstract

eHealth is an appealing medium to improve healthcare and its value (in addition to standard care) has been assessed in previous studies. We aimed to assess whether an eHealth intervention could improve asthma control while reducing 50% of routine outpatient visits.In a multicentre, randomised controlled trial with a 16-month follow-up, asthmatic children (6-16 years) treated in eight Dutch hospitals were randomised to usual care (4-monthly outpatient visits) and online care using a virtual asthma clinic (VAC) (8-monthly outpatient visits with monthly web-based monitoring). Outcome measures were the number of symptom-free days in the last 4 weeks of the study, asthma control, forced expiratory volume in 1 s, exhaled nitric oxide fraction, asthma exacerbations, unscheduled outpatient visits, hospital admissions, daily dose of inhaled corticosteroids and courses of systemic corticosteroids.We included 210 children. After follow-up, symptom-free days differed statistically between the usual care and VAC groups (difference of 1.23 days, 95% CI 0.42-2.04; p=0.003) in favour of the VAC. In terms of asthma control, the Childhood Asthma Control Test improved more in the VAC group (difference of 1.17 points, 95% CI 0.09-2.25; p=0.03). No differences were found for other outcome measures.Routine outpatient visits can partly be replaced by monitoring asthmatic children eHealth.

Barriers and Facilitators When Implementing Web-Based Disease Monitoring and Management as a Substitution for Regular Outpatient Care in Pediatric Asthma: Qualitative Survey Study

“…The 8 hospitals originally participating in the randomized controlled trial (RCT) [ 11 ] were approached to also collaborate in this study. Of these, 6 hospitals agreed to participate, and 2 hospitals declined for logistic reasons.…”

“…After 16 months of follow-up, the number of symptom-free days and the degree of asthma control improved in children who received care using the VAC, and we concluded that routine outpatient visits could partly be replaced by monitoring asthmatic children using eHealth. [ 11 ] Furthermore, the outcome of the cost-effectiveness analysis was in favor of using Web-based monitoring as a substitution for outpatient visits from a health economics perspective [ 12 ].…”

COVID-19 and telehealth, education, and research adaptations

“…Studies reveal that although overall satisfaction with telehealth encounters is high in patients, a significant minority still prefer face to face consultations [5][6][7]. There is early evidence showing that telehealth care is as effective as in person care when treating chronic conditions like childhood asthma [8,9]. While telehealth technology is rapidly improving technological limitations still lead to suboptimal and frustrating provider-patient telehealth interactions [6,7].…”

COVID-19: Technology-Supported Remote Assessment of Pediatric Asthma at Home

“…eHealth is a catch-all concept of care using home monitoring devices, communication tools, and ambulatory ICT to organize care. Despite recent validations of eHealth strategies and devices for use at home (14) and the promising results of a few eHealth studies conducted in childhood asthma (13,15), the actual uptake of eHealth programs into daily clinical practice is scarce. Published eHealth studies are difficult to compare due to heterogeneity in study endpoints and designs which are usually specifically tailored to healthcare systems and cultural backgrounds.…”