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• Telehealth advances in enhancing paediatric asthma care through safe remote consultations
  Lucy Barnard, Rahul Chodhari
  Published on: 16 August 2024

• Published on: 16 August 2024

  Telehealth advances in enhancing paediatric asthma care through safe remote consultations

  • Lucy Barnard, Medical Student King's College London
  • Other Contributors:
    • Rahul Chodhari, Consultant Paediatrician with an interest in Respiratory medicine and Allergy

  Dear Editor,

  We were interested to read the recent article on patient safety in remote primary care encounters by Payne et al. We have been reviewing the use of remote consultations specifically for paediatric asthma patients and would like to thank the authors for their work.

  Firstly, we agree with the authors’ findings that a remote environment may exacerbate existing inequalities such as economic and language barriers. We would add that an additional factor that must be assessed is a patient’s ability to use technology. Pinnock et al. highlight the risk of virtual consultations to those who lack “e-literacy (or digital healthcare literacy)” (2). These patients must be identified and offered additional support or alternative methods of consultation to maintain the utmost level of care.

  Payne et al. highlight the need for a more definitive approach to escalating care rather than a “rule of thumb” or “if in doubt, put it down as urgent” approach (1). We would echo that there need to be clear guidelines and more specific thresholds for escalating care from remote to in-person visits. One suggestion by Galway et al. is having a lower threshold for seeing younger children face to face (3). Galway et al. also suggest having alternative “red-flag” signs that are unique to the remote setting. For example, multiple calls from a patient may indicate the need to escalate their care to face-to-face. More of these red-flag signs unique to this setting need to be...

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  Dear Editor,

  We were interested to read the recent article on patient safety in remote primary care encounters by Payne et al. We have been reviewing the use of remote consultations specifically for paediatric asthma patients and would like to thank the authors for their work.

  Firstly, we agree with the authors’ findings that a remote environment may exacerbate existing inequalities such as economic and language barriers. We would add that an additional factor that must be assessed is a patient’s ability to use technology. Pinnock et al. highlight the risk of virtual consultations to those who lack “e-literacy (or digital healthcare literacy)” (2). These patients must be identified and offered additional support or alternative methods of consultation to maintain the utmost level of care.

  Payne et al. highlight the need for a more definitive approach to escalating care rather than a “rule of thumb” or “if in doubt, put it down as urgent” approach (1). We would echo that there need to be clear guidelines and more specific thresholds for escalating care from remote to in-person visits. One suggestion by Galway et al. is having a lower threshold for seeing younger children face to face (3). Galway et al. also suggest having alternative “red-flag” signs that are unique to the remote setting. For example, multiple calls from a patient may indicate the need to escalate their care to face-to-face. More of these red-flag signs unique to this setting need to be identified and then relayed to professionals during specific training on consulting remotely.

  Payne et al. highlight that one major challenge to remote consults is the inability to perform physical examination of patients. We agree that the inability to examine a patient means that remote consults are not always appropriate. With particular regards to asthma patients, Eguiluz-Gracia et al. suggested that this limited or inaccurate clinical information can lead to an increased risk of corticosteroid over-prescription (5). As Payne et al. rightly point out, a preliminary rather than definitive diagnosis is perhaps the way forward. Payne et al. also described the limited opportunities for demonstrating or checking patients’ technique, however Agerskov et al. concluded that spirometry can still be effectively carried out remotely (4). Our own recommendation and clinician practice is not to use remote consultations for first diagnostic consultation but rather in a follow-up setting, and instead arrange in-person consultations for an initial diagnosis.

  Lastly, we would like to highlight some risks. Payne et al. identify the dangers of relying on information from a third party due to it potentially being inaccurate. In addition to this, another potential danger that requires research is whether remote consultations still enable doctors to safeguard effectively. Southgate et al. also highlight that there is a lack of literature on safeguarding in remote consults (6). We feel that resolving this is paramount to the future of remote consultations and maintaining patient safety.

  References:

  1. Payne R, Clarke A, Swann N, et al Patient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis BMJ Quality & Safety Published Online First: 28 November 2023. doi: 10.1136/bmjqs-2023-016674

  2. Pinnock H, Noble M, Lo D, et al. Personalised management and supporting individuals to live with their asthma in a primary care setting. Expert Rev Respir Med. 2023;17(7):577-596. doi:10.1080/17476348.2023.2241357

  3. Galway N, Stewart G, Maskery J, et al. Fifteen-minute consultation: A practical approach to remote consultations for paediatric patients during the COVID-19 pandemic. Arch Dis Child Educ Pract Ed. 2021;106(4):206-209. doi:10.1136/archdischild-2020-320000

  4. Agerskov N, Coughlin S, Parrott H, et al. Quality of Unsupervised Home Spirometry in Children with Asthma. B9. B009 PATIENT, FAMILY, AND PROVIDER EXPERIENCES IN CRITICAL CARE AND CHRONIC PATIENT MANAGEMENT. May 1, 2021, A1088-A1088

  5. Eguiluz-Gracia I, van den Berge M, Boccabella C, et al. Real-life impact of COVID-19 pandemic lockdown on the management of pediatric and adult asthma: A survey by the EAACI Asthma Section. Allergy. 2021;76(9):2776-2784. doi:10.1111/all.14831

  6. Southgate G, Yassaee AA, Harmer MJ, et al. Use of Telemedicine in Pediatric Services for 4 Representative Clinical Conditions: Scoping Review. J Med Internet Res. 2022;24(10):e38267. Published 2022 Oct 26. doi:10.2196/38267

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  Conflict of Interest:
  None declared.

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