Weaknesses of telemedicine in pediatric and adolescent asthmatic patients
Challenge
Description of the barrier
Key challenges in telemedicine implementation
Detailed barriers to effective telemedicine adoption.
Preference for personal interaction
Doctor-patient interaction is highly valued*. Many patients feel more reassured when physically examined by their doctor, despite clinical history being the primary tool in allergy diagnosis.
Disconnect between telemedicine results and daily practice integration
A real gap exists in incorporating telemedicine outcomes into routine medical records#.
Concerns about privacy and confidentiality
Limited trust in the ability of telemedicine tools to ensure privacy and confidentiality.
Challenges in data transfer
Significant difficulty transferring information from telemedicine platforms to standard healthcare management programs.
Inequitable technology use
Lack of uniformity in technology usage among the population, where errors in responses may lead to misinterpretation of results.
Lack of evidence
Currently, there are no systematic reviews to support outcomes or clarify cost-benefit (profitability, standardization, among others).
*Despite the increase (> 70%) in the use of telemedicine during the first lockdown in 2020, the numbers dropped drastically after in-person interaction resumed, with usage rates in subsequent waves falling to 5–10% [38]. #A project related to the use of an asthma app demonstrated low patient interest, with participation rates below 5% [39]
Declarations
Acknowledgments
The authors thank Dr. Carmelo Escudero and Dr. Sonsoles Infante, both coordinators of the Pediatric Allergy Committee of the Spanish Society of Allergology and Clinical Immunology, for their invaluable assistance in the development of this project. We also extend our gratitude to Dr. Silvia Sánchez-García for her collaboration in this project as the coordinator of the Pediatric Respiratory Allergy Working Group of the Pediatric Allergy Committee of the Spanish Society of Allergology and Clinical Immunology.
Author contributions
PMB, OAG, PCF, SFC, MESM, and MTP: Investigation, Writing—original draft, Writing—review & editing, Validation. TGB: Investigation, Writing—original draft, Writing—review & editing, Validation, Conceptualization, Supervision. All authors read and approved the submitted version.
Conflicts of interest
The authors declare no conflicts of interest related to this work.
Ethical approval
Not applicable.
Consent to participate
Not applicable.
Consent to publication
Not applicable.
Availability of data and materials
The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
ACTUALIZACIÓN 5.4 DE LA GUÍA GEMA [Internet].[cited 2024 Dec 24]. Available from: http://www.gemasma.com
Alvarez-Perea A, Sánchez-García S, Cano RM, Antolín-Amérigo D, Tsilochristou O, Stukus DR. Impact Of “eHealth” in Allergic Diseases and Allergic Patients.J Investig Allergol Clin Immunol. 2019;29:94–102. [DOI] [PubMed]
Davies B, Kenia P, Nagakumar P, Gupta A. Paediatric and adolescent asthma: A narrative review of telemedicine and emerging technologies for the post-COVID-19 era.Clin Exp Allergy. 2021;51:393–401. [DOI] [PubMed] [PMC]
Alvarez-Perea A, Dimov V, Popescu F, Zubeldia JM. The applications of eHealth technologies in the management of asthma and allergic diseases.Clin Transl Allergy. 2021;11:e12061. [DOI] [PubMed] [PMC]
Almonacid C, Blanco-Aparicio M, Domínguez-Ortega J, Giner J, Molina J, Plaza V, et al. Teleconsultation in the follow-up of the asthma patient. Lessons after COVID-19.Arch Bronconeumol. 2021;57:13–4. [DOI] [PubMed] [PMC]
Kim CH, Lieng MK, Rylee TL, Gee KA, Marcin JP, Melnikow JA. School-Based Telemedicine Interventions for Asthma: A Systematic Review.Acad Pediatr. 2020;20:893–901. [DOI] [PubMed] [PMC]
Rodríguez-Sánchez F. Proceso de elaboración y novedades del código de deontología médica español 2022.Cuad Bioet. 2023;34:143–53. Spanish. [DOI] [PubMed]
Issue Information-Declaration of Helsinki.J Bone Miner Res. 2019;34:BMi–BMii. [DOI] [PubMed]
Blakey JD, Bender BG, Dima AL, Weinman J, Safioti G, Costello RW. Digital technologies and adherence in respiratory diseases: the road ahead.Eur Respir J. 2018;52:1801147. [DOI] [PubMed] [PMC]
Nichols A, Sonnappa-Naik M, Gardner L, Richardson C, Orr N, Jamalzadeh A, et al. COVID-19 and delivery of difficult asthma services.Archives of Disease in Childhood. 2022;107:e15. [DOI] [PubMed]
Gerzon FLGR, Jöbsis Q, Bannier MAGE, Winkens B, Dompeling E. Discrepancy between Lung Function Measurements at Home and in the Hospital in Children with Asthma and CF.J Clin Med. 2020;9:1617. [DOI] [PubMed] [PMC]
Morton RW, Elphick HE, Rigby AS, Daw WJ, King DA, Smith LJ, et al. STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma.Thorax. 2017;72:347–54. [DOI] [PubMed]
van den Wijngaart LS, Roukema J, Boehmer ALM, Brouwer ML, Hugen CAC, Niers LEM, et al. A virtual asthma clinic for children: fewer routine outpatient visits, same asthma control.Eur Respir J. 2017;50:1700471. [DOI] [PubMed]
Shah AC, Badawy SM. Telemedicine in Pediatrics: Systematic Review of Randomized Controlled Trials.JMIR Pediatr Parent. 2021;4:e22696. [DOI] [PubMed] [PMC]
Burke BL Jr, Hall RW, Care SOT, Dehnel PJ, Alexander JJ, Bell DM, et al. Telemedicine: Pediatric Applications.Pediatrics. 2015;136:e293–308. [DOI] [PubMed] [PMC]
Halterman JS, Fagnano M, Tajon RS, Tremblay P, Wang H, Butz A, et al. Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity: A Randomized Clinical Trial.JAMA Pediatr. 2018;172:e174938. [DOI] [PubMed] [PMC]
Perry TT, Halterman JS, Brown RH, Luo C, Randle SM, Hunter CR, et al. Results of an asthma education program delivered via telemedicine in rural schools.Ann Allergy Asthma Immunol. 2018;120:401–8. [DOI] [PubMed] [PMC]
Ferrante G, Licari A, Marseglia GL, Grutta SL. Digital health interventions in children with asthma.Clin Exp Allergy. 2021;51:212–20. [DOI] [PubMed] [PMC]
Padilla-Galo A, Soto-Campos JG, Casas-Maldonado F, Álvarez-Gutierrez FJ, Morales-García C, Romero-Falcón A, et al. Documento de consenso: retos actuales en la asistencia de pacientes con asma en época de pandemia por SARS-COV-2 en las Unidades de asma de Andalucía.Rev Esp Patol Torac. 2021;33:114–20. Spanish.
Persaud YK, Portnoy JM. Ten Rules for Implementation of a Telemedicine Program to Care for Patients with Asthma.J Allergy Clin Immunol Pract. 2021;9:13–21. [DOI] [PubMed] [PMC]
Poowuttikul P, Seth D. New Concepts and Technological Resources in Patient Education and Asthma Self-Management.Clin Rev Allergy Immunol. 2020;59:19–37. [DOI] [PubMed]
Almonacid Sánchez C. Nuevas tecnologías y asma.Rev Asma. 2018;3:16–20. Spanish.
Sánchez CA, Aparicio MB, Ortega JD, Donaire JG, Paris JM, Marcos NS, et al. Multidisciplinary Consensus for the Monitoring and Control of Asthma Through Telemedicine. The COMETA Project.Open Respir Arch. 2021;3:100098. [DOI] [PubMed] [PMC]
Haleem A, Javaid M, Singh RP, Suman R. Telemedicine for healthcare: Capabilities, features, barriers, and applications.Sens Int. 2021;2:100117. [DOI] [PubMed] [PMC]
Katwa U, Rivera E. Asthma Management in the Era of Smart-Medicine: Devices, Gadgets, Apps and Telemedicine.Indian J Pediatr. 2018;85:757–62. [DOI] [PubMed]
Perry TT, Marshall A, Berlinski A, Rettiganti M, Brown RH, Randle SM, et al. Smartphone-based vs paper-based asthma action plans for adolescents.Ann Allergy Asthma Immunol. 2017;118:298–303. [DOI] [PubMed]
Culmer N, Smith T, Stager C, Wright A, Burgess K, Johns S, et al. Telemedical Asthma Education and Health Care Outcomes for School-Age Children: A Systematic Review.J Allergy Clin Immunol Pract. 2020;8:1908–18. [DOI] [PubMed]
Radhakrishnan D, Higginson A, Thipse M, Tessier M, Radhakrishnan A. Optimizing pediatric asthma education using virtual platforms during the COVID-19 pandemic.Allergy Asthma Clin Immunol. 2022;18:72. [DOI] [PubMed] [PMC]
van den Wijngaart LS, Kievit W, Roukema J, Boehmer ALM, Brouwer ML, Hugen CAC, et al. Online asthma management for children is cost-effective.Eur Respir J. 2017;50:1701413. [DOI] [PubMed]
Xu C, Jackson M, Scuffham PA, Wootton R, Simpson P, Whitty J, et al. A randomized controlled trial of an interactive voice response telephone system and specialist nurse support for childhood asthma management.J Asthma. 2010;47:768–73. [DOI] [PubMed]
Beerthuizen T, Voorend-van Bergen S, van den Hout WB, Vaessen-Verberne AA, Brackel HJ, Landstra AM, et al. Cost-effectiveness of FENO-based and web-based monitoring in paediatric asthma management: a randomised controlled trial.Thorax. 2016;71:607–13. [DOI] [PubMed]
Snoswell CL, Rahja M, Lalor AF. A Systematic Review and Meta-Analysis of Change in Health-Related Quality of Life for Interactive Telehealth Interventions for Patients With Asthma.Value Health. 2021;24:291–302. [DOI] [PubMed]
Jaimini U, Thirunarayan K, Kalra M, Venkataraman R, Kadariya D, Sheth A. How Is My Child's Asthma? Digital Phenotype and Actionable Insights for Pediatric Asthma.JMIR Pediatr Parent. 2018;1:e11988. [DOI] [PubMed] [PMC]
Morais-Almeida M, Aguiar R, Martin B, Ansotegui IJ, Ebisawa M, Arruda LK, et al. COVID-19, asthma, and biological therapies: What we need to know.World Allergy Organ J. 2020;13:100126. [DOI] [PubMed] [PMC]
Jácome C, Almeida R, Pereira AM, Amaral R, Mendes S, Alves-Correia M, et al. Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence: Mixed Methods Study.JMIR Mhealth Uhealth. 2021;9:e26442. [DOI] [PubMed] [PMC]
Knibb RC, Alviani C, Garriga-Baraut T, Mortz CG, Vazquez-Ortiz M, Angier E, et al. The effectiveness of interventions to improve self-management for adolescents and young adults with allergic conditions: A systematic review.Allergy. 2020;75:1881–98. [DOI] [PubMed]
Belisario JSM, Huckvale K, Greenfield G, Car J, Gunn LH. Smartphone and tablet self management apps for asthma.Cochrane Database Syst Rev. 2013;2013:CD010013. [DOI] [PubMed] [PMC]
Khaleva E, Knibb R, DunnGalvin A, Vazquez-Ortiz M, Comberiati P, Alviani C, et al. Perceptions of adolescents and young adults with allergy and/or asthma and their parents on EAACI guideline recommendations about transitional care: A European survey.Allergy. 2022;77:1094–104. [DOI] [PubMed]
Vazquez-Ortiz M, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, et al. Understanding the challenges faced by adolescents and young adults with allergic conditions: A systematic review.Allergy. 2020;75:1850–80. [DOI] [PubMed]
Khaleva E, Vazquez-Ortiz M, Comberiati P, DunnGalvin A, Pite H, Blumchen K, et al. Current transition management of adolescents and young adults with allergy and asthma: a European survey.Clin Transl Allergy. 2020;10:40. [DOI] [PubMed] [PMC]
Roberts G, Vazquez-Ortiz M, Knibb R, Khaleva E, Alviani C, Angier E, et al. EAACI Guidelines on the effective transition of adolescents and young adults with allergy and asthma.Allergy. 2020;75:2734–52. [DOI] [PubMed]
Jochmann A, Artusio L, Jamalzadeh A, Nagakumar P, Delgado-Eckert E, Saglani S, et al. Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children.Eur Respir J. 2017;50:1700910. [DOI] [PubMed]
Haynes SC, Kamerman-Kretzmer R, Khan SS, Crossen S, Lieng MK, Marcin JP, et al. Telemedicine use for pediatric asthma care: a mixed methods study.J Asthma. 2022;59:2431–40. [DOI] [PubMed]
