School-Based Telemedicine Interventions for Asthma: A Systematic Review

Kim, Christopher H.; Lieng, Monica K.; Rylee, Tina L.; Gee, Kevin A.; Marcin, James P.; Melnikow, Joy A.

BACKGROUND: School health systems are increasingly investing in telemedicine platforms to address acute and chronic illnesses. Asthma, the most common chronic illness in childhood, is of particular interest given its high burden on school absenteeism. OBJECTIVES: Conduct a systematic review evaluating impact of school-based telemedicine programs on improving asthma-related outcomes. DATA SOURCES: PubMed, Cochrane CENTRAL, CINAHL, ERIC, PsycINFO, Embase, and Google Scholar STUDY ELIGIBILITY CRITERIA: Original research, including quasi-experimental studies, without restriction on the type of telemedicine. PARTICIPANTS: School-aged pediatric patients with asthma and their families. INTERVENTIONS: School-based telemedicine. STUDY APPRAISAL AND SYNTHESIS METHODS: Two authors independently screened each abstract, conducted full-text review, assessed study quality, and extracted information. A third author resolved disagreements. RESULTS: Of 371 articles identified, 7 were included for the review. Outcomes of interest were asthma symptom-free days, asthma symptom frequency, quality-of-life, healthcare utilization, school absences, and spirometry. 4/7 studies reported significant increases in symptom-free days and/or decrease in symptom frequency. 5/6 reported increases in at least one quality-of-life metric, 2/7 reported a decrease in at least one healthcare utilization metric, 1/3 showed reductions in school absences, and 1/2 reported improvements in spirometry measures. LIMITATIONS: Variability in intervention designs and outcome measures make comparisons and quantitative analyses across studies difficult. Only 2/7 studies were randomized controlled trials. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: High-quality evidence supporting the use of school-based telemedicine programs to improve patient outcomes is limited. While available evidence suggests benefit, only two comparative trials were identified, and the contribution of telemedicine to these studies’ results is unclear.