P1004 - Getting A Head Start on Asthma: A Preschool Based Telehealth Initiative

Background:
It is well-known that there is a high prevalence of asthma in preschool age children. In Head Start programs, the prevalence of asthma is commonly even higher than in the general population. Asthma management in young children can be complicated by many factors, including access to care. Preschool enrollment represents a unique opportunity for intervention and improving access to care using telehealth. The telehealth modality can have an important role in both symptom monitoring and treatment.

Purpose:
To improve asthma-education and asthma-care for children with asthma enrolled at Head Start in Southbridge and Webster, MA.

Methods:
18 children with asthma, ages 3 to 5 years, who were enrolled at Head Start participated in the study. 2 focus groups with care-givers were held to assess needs. The telehealth liaison was trained in the use of the digital stethoscope and the telehealth modality. Each participant had two telehealth visits at the Head Start site during which exam data were recorded and the Asthma Control Test (ACT) and the Asthma Action Plan were reviewed. The data were stored in a "virtual waiting room" and reviewed by the clinician who formulated an assessment and plan and made necessary changes to the action plan. Written communication with care-givers was sent after each visit. (See Figure 1). Care-givers were surveyed pre and post-study.
Outcome measures: Care-giver satisfaction; ACT scores; asthma-related absences; health-care needs identified.

Results:
11 of the 18 study participants were identified as having intermittent asthma, 6 had mild-persistent asthma and 1 had moderate-persistent asthma. There were 11 post-focus group survey respondents. All respondents reported that they learned something new about asthma in the focus group and 3 reported that they changed the management of their child's asthma after the focus-group session (p=0.625 with McNemar test analysis).
Each study participant participated in 2 telehealth visits at Head Start. A two-tailed paired T-test (Figure 2) revealed that there was a statistically significant (P<.001) increase in mean ACT score after the telehealth visits (mean=21, 95% CI=17+/-1.12, SD=1.71) compared to before the telehealth visits (mean=17, 95% CI=21+/-2.94, SD=2.43). Parental perception of asthma control also increased, but insignificantly (p=0.5 with McNemar test analysis). There was no statistical difference in rate of asthma-related absences before, during and after the study period (using Poisson regression analysis). All respondents reported that they thought telehealth visits in schools were useful.

Conclusion:
Findings suggest that the telehealth platform is a useful modality for improving asthma-care in a preschool-based setting and there was an overall improvement in asthma-understanding and asthma-care for study participants. There is the potential for the telehealth modality to bridge care-gaps for underserved populations in a variety of school-based settings; continued and further work is needed.