P0998 - A Mixed Methods Evaluation of the Implementation of Asthma Care in Rural School-Based Telehealth Clinics

Background/Purpose: Telehealth-delivered school-based asthma care offers an opportunity to overcome typical barriers to providing asthma care to children compared to the traditional setting. Exploring the key components of care and internal and external factors affecting delivery may facilitate implementation of these programs, which have been shown to expand care. We used a dissemination and implementation science approach to characterize barriers and facilitators to asthma care in a telehealth-delivered school-based program available in over 50 South Carolina schools, of which 91% serve students who qualify for free or reduced lunch.

Methods: This prospective, mixed methods study assessed barriers and facilitators to school-based asthma telehealth delivery, guided by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework (see Figure). Data were gathered using web-based surveys of school nurses and focus groups with teachers, administrators and school nurses. Surveys and focus groups evaluated inner and outer context factors related to telehealth implementation. Descriptive statistics were performed on the survey responses. Template analysis was used to analyze focus group data guided by the EPIS model. The findings between the data sources were merged to maximize depth and breadth of information.

Results: Of the 55 surveys distributed, 36 were completed (65% response rate). Over 50% of schools provided asthma-related telehealth services. In addition to asthma care delivery through telehealth, school nurses reported high rates of independently providing acute asthma care (86%), identifying students with asthma (81%), instructing proper inhaler technique (89%) and delivering controller medications daily (75%). Telehealth played a key role in developing a treatment plan (58%) and non-acute asthma management care (61%). While few nurses endorsed financial or school leadership and support barriers, over 60% endorsed parental involvement (e.g., consent, involvement in care planning, trust in telehealth) and a lack of time due to competing demands as key barriers to delivering asthma care (see Table).

Focus groups were completed in high, medium and low telehealth utilizers in 3 counties (N=9). The majority of participants rated telehealth favorably with appreciation for meeting students’ healthcare needs and positive experiences with set-up processes and communication between the school and clinic personnel. Key themes confirmed that parental engagement and practical challenges were top implementation barriers. Schools desired improved parental consent processes, marketing tools to educate parents and staff about telehealth and support to build systematic processes to facilitate education and follow-up visits.

Conclusion: We identified key barriers and facilitators to implementation of a school-based telehealth asthma program covering an underserved population. Addressing these components of care when expanding telehealth services will promote successful implementation.