School-Based Telemedicine Treatment Model
New School-Based Hypertension Telemedicine Program Builds on Success of Asthma Treatment Model
A new pilot partnership between Rochester City School District (RCSD) and the Department of Pediatric Nephrology at UR Medicine’s Golisano Children’s Hospital (GCH) will help students receive telemedicine treatment for hypertension.
The partnership, which is being funded through the Department of Pediatrics, will adopt the infrastructure from GCH’s successful School-Based Asthma Therapy (SBAT) program, which has helped reduce emergency department visits for asthma by half using a combination of telemedicine and on-site asthma therapy treatment delivered by school nurses.
This new hypertension program addresses two growing concerns: the rise of high blood pressure in children, and the prevalence of this condition among urban, low-income populations who experience obstacles making it to medical visits.
“3 or 4 percent of children now have hypertension, which makes it a relatively common problem,” said Marc Lande, M.D., M.P.H., chief of Pediatric Nephrology at GCH, “when we saw that the no-show rate for our hypertension clinic was greater than that for general nephrology clinic, it made us suspect that there were barriers for patients with this medical problem.”
Pediatric hypertension has increased fourfold in the United States during the past 40 years. Although there is no single cause, there is a correlation with the increase of children with obesity during the same time period.
Gone untreated, children with hypertension face larger risks of heart attack, stroke, and kidney failure as adults, according to research from Global Pediatric Health. “If we can get blood pressure under control with youth, we can help ameliorate the problems,” said Lande.
To help treat students, Lande’s team has provided specialized training in measuring blood pressure to telemedicine technicians who will visit the school periodically to conduct virtual appointments with Pediatric Nephrology doctors at GCH. “We’re using the same approach of the asthma program, which has had real success preventing barriers to care, to achieve similar results,” said Lande.
Adopting the Success of Asthma Program
GCH’s school-based asthma program is led by Jill Halterman, M.D., M.P.H. Halterman is a general pediatrician, not an asthma specialist. But, when she saw how asthma disproportionately affected low-income, inner-city children, she was compelled help.
“My goal was to improve the delivery of care to underserved children who are suffering the greatest burden from asthma,” said Halterman, executive vice chair and associate professor of Pediatrics.
More than 10 percent of children in the district suffer from asthma, and in Monroe County, hospitalization rates for asthma are five times higher in the city than in suburban areas. Due to logistical barriers to care, however, children living in the district often don’t receive the daily preventive asthma medication that they need. As a result, their symptoms worsen, they miss school, and their parents have to miss work. Some children end up in the emergency department or in extended hospital stays.
“After the crisis passes, many of these kids don’t receive follow-up care,” said Christy Lamberton, a nurse at School No. 45. “So they never get on the right treatment plan, and their symptoms never improve.”
As part of the SBAT initiative, children receive their preventive asthma medication each day under the guidance of a school nurse or health aide. The model improved children’s symptoms, reduced absenteeism, and allowed children to be more active.
“We have seen that when kids consistently get their maintenance medication at school, they notice after a time, they feel better and are able to participate more,” said Lamberton.
The program eventually introduced a telemedicine component that connected children in schools to primary care providers in the office. These providers help to determine the best form of therapy and then stay readily available in a child’s care. Halterman’s study of the program found that children who receive both telemedicine support and therapy at school are almost half as likely to need an emergency room or hospital visit for asthma.
Not only has Lande adopted Halterman’s program for hypertension, but other school districts across the country have utilized her approach for asthma as well. Nine other sites, including districts in New York City, Philadelphia, and Columbus, OH, have consulted with Halterman’s team and implemented a similar initiative. In Columbus, Elizabeth Allen, M.D., a pediatric pulmonologist and the medical director for quality, came across the program after she and her team identified asthma improvement as one of their top priorities.
“We started looking into Dr. Halterman’s program and it stood out as effective and well-vetted to work,” said Allen. “It’s effective, because for families who have barriers to receiving quality asthma care, you need to give added assistance to ensure children have the right medications — and that they receive those medications on a regular basis.”
Lande is looking to enroll 15 patients to start the hypertension program. These are existing patients in the GCH hypertension clinic who face difficulties scheduling follow-up appointments. A telemedicine technician will visit schools periodically, set-up an appointment with a GCH Nephrology doctor using an iPad, and conduct an assessment. The GCH doctor will then call the parents afterward to set up a follow-up appointment.
The overall goal is to help families make more visits and improve blood pressure control, with the intention of expanding to more schools with increased funding. “It has been well-received thus fair, and has helped families be timely with visits, adjust their care and get hypertension under control,” said Lande.
In addition to getting more timely treatment, Lande emphasizes that healthier living and lifestyle modifications - such as regular exercise and dietary changes - should also be part of the overall treatment strategy for hypertension. “This approach is much more successful when done as a family,” he said.
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