181 - Telemedicine Use and Asthma Management in Primary Care: A Retrospective Cross-Sectional Study

Publication Number: 4178.181

Mary Kate Kelly, Children's Hospital of Philadelphia, Vincentown, NJ, United States; Alexander G. Fiks, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Samuel Wittman, University of Pittsburgh, Pittsburgh, PA, United States; Janani Ramachandran, Childrens Hospital of Philadelphia, Houston, TX, United States; Kristin E. Davis, AAP, Itasca, IL, United States; Jennifer Steffes, American Academy of Pediatrics, Itasca, IL, United States; Donna L. Harris, AAP, itasca, IL, United States; Everly Macario, American Academy of Pediatrics, Chicago, IL, United States; Matthew WH. Jones, OCHIN, Inc., TULSA, OK, United States; Brigit Hatch, Oregon Health & Science University School of Medicine, Portland, OR, United States; Julia E.. Szymczak, University of Utah School of Medicine, Salt Lake City, UT, United States; Dara D. Mendez, University of Pittsburgh, Pittsburgh, PA, United States; Jonathan Yabes, University Of Pittsburgh, Pittsburgh, PA, United States; Robert Grundmeier, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Kristin Ray, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Jody L. Butto, Aurora Pediatrics, Anchorage, AK, United States

Background: Asthma is one of the most common chronic conditions in children. Telemedicine (TM) visits may enhance families' ability to attend primary care visits, discuss asthma symptoms, and titrate medications. How primary care practices are incorporating TM into their care of children with asthma and its impact are not known.

Objective: To assess whether 2023-24 practice-level TM use for asthma primary care was associated with 2 quality metrics: documentation of asthma severity and, among those with persistent asthma, controller medication prescribing.

Design/Methods: We analyzed electronic health record data for children 2-18 years who received primary care for asthma at 829 community health organizations affiliated with OCHIN, 76 practices from 2 regional health systems, and 46 independent practices from the American Academy of Pediatrics national Pediatric Research in Offices Settings (PROS) network. Using data from 2016-24, we identified children who had 2 or more primary care visits at least 6 months apart with an asthma diagnosis (ICD-10 J45), with at least one visit during 2023-24. We quantified the rate of TM use at the practice level as the number of TM asthma visits per 100 patients in 2023-24. We then categorized practices into three groups: those at or above the third quartile of TM use (high TM), those with TM use below the third quartile of TM use (low TM), and those with no TM for asthma. The outcomes were asthma severity documentation (based on ICD-10 codes) and asthma controller medication use (any prescriptions for those with persistent asthma) in 2023-24. To evaluate the relationship between TM use category (high, low, or no TM use) and these outcomes, we used logistic regression with practice-level random effects and controlling for covariates in Table 1.

Results: Our sample included 95,123 children with asthma: 23% were seen at high TM practices, 60% at low TM practices, and 17% at no TM practices. Practice-level TM use was not associated with asthma severity documentation. However, among those with persistent asthma, high practice-level TM use was significantly associated with asthma controller medication prescribing. Compared to practices with no TM use for asthma care, high TM practices had a 3.1 percentage point greater rate of controller prescription among children with persistent asthma (95% CI 0.31%, 5.92%) (Table 2).

Conclusion(s): Primary care practices with higher TM use were more likely to prescribe controller medications to children with persistent asthma. Our results suggest that TM integrated into primary care practice may support evidence-based asthma care.

Table 1. Characteristics of children receiving primary care for asthma in 2023-2024, by practice-level telemedicine (TM)[1] use


Table 2. Asthma outcomes by child primary care site telemedicine (TM)[1] use