Background and objective: Individuals from historically marginalized populations face structural and social determinants of health that create barriers to receiving specialty asthma care. School-based specialist care delivered via telehealth offers a potential solution for children with uncontrolled asthma. This study evaluated the reach, implementation, and effectiveness of school-based telehealth asthma clinics led by pediatric pulmonologists in historically marginalized neighborhoods.
Methods: Patients completed at least one visit with an asthma specialist via telehealth, including assessments of asthma control, lung function, exacerbations, and healthcare utilization. Descriptive analyses and means comparison tests of electronic health record data were conducted to examine outcomes.
Results: Asthma specialists provided telehealth care for 54 patients (Mage = 12.23, SD = 3.71) between May 2019 and May 2023. The clinics reached a high percentage of individuals from historically marginalized populations (90.7% Black or African American, 92.6% public insurance) who had not previously received specialty asthma care (51.9%). Twenty-three patients (42.6%) were seen more than once in the school-based telehealth asthma clinics (M = 3.43 visits, SD = 1.53). Asthma control significantly improved for those patients, t(19) = 2.61, p = 0.017, Cohen's d = 0.58, with 30% improving from poorly controlled to well-controlled. Exacerbations and healthcare utilization decreased.
Conclusions: Specialist-delivered, school-based telehealth asthma clinics effectively reached patients from historically marginalized backgrounds and improved clinical outcomes. This school-based telehealth model can be applied across settings to reach patients who might not otherwise have access to specialty care.
Keywords: asthma; asthma outcomes; children; health equity; schools; telehealth; telemedicine.
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