Effect of the Telemedicine Enhanced Asthma Management-Uniting Providers (TEAM-UP) Program on Asthma Outcomes: A Randomized Clinical Trial.

Abstract

To evaluate a school-based intervention for children with moderate-severe persistent/poorly controlled asthma, adding telemedicine consultations with specialists to school-based directly observed therapy of preventive asthma medications in order to optimize management. From 2018 to 2024 children aged 4-12 years with moderate-severe/poorly controlled asthma were randomized to Telemedicine Enhanced Asthma Management-Uniting Providers (TEAM-UP) or enhanced usual care. TEAM-UP included daily school-based directly observed therapy and telemedicine visits with asthma specialists. The primary outcome was mean symptom-free days/2 weeks. Analyses used linear mixed and generalized estimating equation models. We enrolled 326 children (62% participation; mean age 8.4 years; 60% male; 58% Black; 35% Hispanic; 80% Medicaid). The majority (84%) of TEAM-UP participants had ≥1 specialist visit and 74% received school-based DOT (excluding the pandemic). We found that children in TEAM-UP vs enhanced usual care had more symptom-free days (mean difference: 1.32; 95% CI 0.58-2.05) and were less likely to miss school (odds ratio: 0.70; 95% CI 0.52-0.96) or require emergency department visits or hospitalizations for asthma (odds ratio: 0.54; 95% CI 0.31-0.96). TEAM-UP significantly improved asthma symptoms and reduced health care use, offering a promising model for asthma care in underserved communities. ClinicalTrials.gov number: NCT03545906 https://clinicaltrials.gov/study/NCT03545906?term=NCT03545906&rank=1.