Using Telemedicine to Care for the Asthma Patient

Current Allergy and Asthma Reports https://doi.org/10.1007/s11882-022-01030-5 ASTHMA (V ORTEGA, SECTION EDITOR) Using Telemedicine to Care for the Asthma Patient Yudy K. Persaud1 Accepted: 23 December 2021 © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022 Abstract Purpose of Review To review the data supporting the use of telemedicine (TM) and to provide practical guidance for practitioners to optimize the care of their asthmatic patients. Recent Findings Previous to the pandemic, TM was little used in various aspects of asthma care. Since the pandemic, TM has been increasingly used in new ways to care for asthma patients at various locations. In addition to direct-to-consumer visits for asthma care, other forms of telehealth visits have been increasing such as facilitated visits, asynchronous, remote patient monitoring, e-consults, and mHealth. Moreover, patient and provider satisfaction with the use of TM has been increasing and is comparable at times with face-to-face visits. In this review, best practices for starting a telemedicine asthma service with patients at home, distant clinic sites, and various other locations, including school-based asthma programs, are reviewed. Summary TM is a valuable adjunct to face-to-face visits for asthma care. Following the recommended best practices can strengthen the implementation of a telemedicine asthma program (TMAP) into clinical practice. Providers must be vigilant in keeping current with the various nuances required for asthma telemedicine care in preparation for the post-pandemic environment. Keywords Telemedicine asthma program · Facilitated virtual visit · Asynchronous · Remote patient monitoring · mHealth Introduction Telemedicine Prior to the COVID-19 pandemic, practitioners have used telemedicine to address access to care issues and to complement medical care. However, the healthcare system saw fundamental changes in healthcare where visits needed to be conducted virtually or, in some cases, a hybrid model was used. During this time, providers and patients used telemedicine out of necessity, and in many instances, as the only option to take care of asthma patients. Visits were performed from a distance to protect the health and welfare of the patient and provider. Now, healthcare systems and private practitioners are working on a contingency plan, post-pandemic, which might incorporate telemedicine options as a standard of care. This article is part of the Topical Collection on Asthma * Yudy K. Persaud 1 Division of Allergy, BronxCare Hospital Systems, Bronx, NY, USA Telemedicine can be performed in different ways depending on the rationale for its use. Live or synchronous TM visits used for asthma care include direct-to-consumer (DTC) and facilitated virtual visits (FVVs). If a visit does not need to be live, then it can be done asynchronously. These include remote patient monitoring (RPM), e-consults, and the use of mobile health (mHealth) applications. As mentioned in a recent editorial, the type of telemedicine platform used should be based on the goal the provider is trying to achieve in asthma care [1••]. Thus, DTC, FVVs, RPM, communication via patient portals, mHealth, and the use of e-consults can be used in various aspects of care. Asthma is a multifaceted disease with a range of severities. It affects over 25 million Americans of which 5 million are children under the age of 18 [2]. It has a tremendous impact on healthcare cost, lost work/school days, and mortality [3]. Although many would like to think that traditional care will go back to “normal,” it is likely that we are at a turning point in healthcare. The traditional asthma care has always involved an in-office visit but new innovative ways to care for our patients efficiently and effectively are desperately needed. Although the pandemic severely limited access to healthcare, telemedicine was instrumental in 13 Vol.:(0123456789) Current Allergy and Asthma Reports enabling providers to continue to care for their patients. This was during a time when patients were not physically able to go to the office. However, providers learned quickly how to care for these patients and some will continue to use a hybrid model in the future. Regardless, the asthma specialist must be prepared for the long haul and for the eventuality of another pandemic. For this review, we will include research findings on past and current uses of telemedicine for asthma care. Unfortunately, during the current pandemic, the use of telemedicine was based on necessity. The primary reason for its use was not evidence-based regarding outcomes, satisfaction, return on investment, etc. We will delve into the different types of telemedicine platforms used, concerns about provider/ patient satisfaction, school-based telehealth services, and the most important question of whether it is as effective as in-person care. Expert opinion will be given on the future use of telemedicine as well as emerging technologies that will be used in taking care of various types of visits for the asthmatic patient. Such visits can be divided into live (or synchronous) which can be used for such care as direct-toconsumer (DTC) and facilitated virtual visits (FVVs). Asynchronous methods would include remote patient monitoring (RPM), mobile health (mHealth) applications, and the use of e-consults (look at Fig. 1). Starting a Telemedicine Asthma Care Program When starting a telemedicine asthma program, one should follow a template to ensure success. The following 10 steps were recently published and should be used when starting a telemedicine asthma program [1••]: 1. 2. 3. 4. 5. 6. Understand the different types of telemedicine and use the appropriate types to treat your patients with asthma Stay up to date with state and federal telemedicine laws Pick a platform Build the infrastructure Offer your patients the telemedicine appointments Get informed consent APP TRACKERS DIRECT TO CONSUMER MOBILE HEALTH ASTHMA CARE FACILITATE D VISITS REMOTE PATIENT MONITORING ECONSULTS SYNCHRONOUS ASYNCHRONOUS Figure 1: Telemedicine Opons to Opmize Asthma Care Fig. 1  Telemedicine options to optimize asthma care 13 Asthma Diary Air Quality Pollen Count Self Reporng Tools DigiHaler Propeller Health, Wearables (Fitbit, Asthma trackers) Home Spirometers, Virtual presence devices. Current Allergy and Asthma Reports 7. 8. 9. 10. Prepare for the visit in advance Perform the visit with your patient Perform a virtual examination Bill for the encounter Selection of a Telemedicine Platform Historically, a telemedicine platform was any virtual technology that was able to connect the provider and patient. Subsequently, numerous platforms were created that included an all-inclusive option for the different types of telemedicine visits. For asthma care, platforms have different options to allow the visit to be performed (Table 1). In facilitat (...truncated)