The Use of Virtual First Pediatric Pulmonology to Solve Asthma Hotspots in Florida

 

15th October 2024

Brian Peddie, Ph.D., Satya Hegde, M.D.

Introduction

Limited access to pediatric subspecialty care, specifically pediatric pulmonology, has significant healthcare concerns for asthma and asthma-related symptoms in children ages 3-17 years. (Keller et al.,, 2020)(Mayer, 2006)(Patel & Raphael, 2023) Parents of over 39 million children have to drive an average distance, depending on the State, from 31 to 95 miles for appointments with the nearest pediatric subspecialists for asthma. (Mayer, 2006) Pediatric pulmonology, that manages pediatric asthma is one of the scarcest subspecialties, given 1.31 physicians per 100,000 children. (Turner, Ricketts, & Leslie, 2020) While lack of access to care is associated with poor control of and increased emergency department (ED) visits due to pediatric asthma, specialist led intervention is associated with decreased ED visits, all cause hospitalizations and hospitalizations from asthma. (Owotomo & Teach, 2022)(Myers, et al., 2023)

 

The National Institutes of Health designated asthma as the highest research priority. It is the most common chronic disease in children with a consistent burden on the health system. The vital role of proper, long-term care for pediatric asthma in reducing the risk of exacerbations, frequently leading to hospitalization, the development of severe asthma in adults, and irrecoverable loss of lung function resulting in chronic obstructive pulmonary disease. (Hamelmann, et al., 2020)

 

The issue of accessibility is being further compounded by the loss of rural healthcare hospitals and facilities with

significant numbers at risk of closure over the next decade. According to recent analyses, more than 700 rural hospitals, which constitute about 31% of all rural hospitals in the country, are facing potential closure due to severe financial challenges. (Becker’s Hospital Review, 2024)(Chief Healthcar Executive, 2024) Of these, approximately 360 hospitals, or 16% of all rural hospitals, are at immediate risk of shutting down within the next two to three years. (Becker’s Hospital Review, 2024)(Chief Healthcare Executive, 2024) Given these statistics, it is likely that a significant number of rural hospitals will close in the next decade unless substantial changes are made to their care delivery paradigms. The closure of these hospitals will have profound impacts on rural communities, leading to increased travel distances for healthcare and potentially poorer health outcomes due to reduced access to essential services. (American Hospital Association, 2022) Further, the long-lasting limitations in access to pediatric subspecialists appear to lead to the increasing number of children cared for by adult-trained subspecialists, likely with knowledge gaps in pediatric disease presentation and evidence-based pediatric care. (Turner, Ricketts, & Leslie, 2020) Once the specialist is gone, the remaining affiliated caregivers quickly disperse and their acumen deteriorates. Accordingly, the physician shortage and the limited access to pediatric subspecialty care may represent a significant healthcare issue as it relates to eradication of disparities in care that result in asthma hotspots. (Mayer, 2006)(Orr, et al., 2024)

 
Asthma Hot Spots in Florida

Florida is a unique state, being one of the fastest-growing in the nation with significant demographic shifts fueled by both domestic migration and international immigration. Between 2022 and 2023, Florida’s population increased by over 2%, with metro areas like Orlando, Tampa, and Miami adding nearly 150,000 new residents in total. This rapid growth presents challenges for traditional, geographically-tethered healthcare delivery models, such as public health clinics and hospitals. (Gramlich & Passel, 2024) Additionally, US immigrant population has surged, with over 1.6 million new immigrants in 2023, marking the largest single-year increase in more than two decades. These shifts necessitate innovative healthcare solutions that can address the state’s evolving needs, particularly in underserved areas where access to specialized care is limited. (Wilder & Mackun, 2024), (Gramlich & Passel, 2024) 

 

Asthma hotspots in the United States are often influenced by a combination of environmental, social, and healthcare factors. Key drivers include air pollution, socioeconomic disparities, and access to healthcare, particularly pediatric pulmonology care. (Friedman, et al., 2022) (Hamelmann, et al., 2020) Florida has unique challenges that exacerbate asthma hotspots, particularly as they relate to pediatric pulmonology care. 

First, Florida’s healthcare infrastructure has not kept pace with demand. A 2023 report highlighted a critical shortage of pediatric specialists, including pulmonologists, particularly in northern and central Florida. (Noah, 2024) (Florida Asthma Coalition, 2023) 

The influx of people, combined with a scarcity of pediatric pulmonology in the healthcare system, has made it difficult to provide adequate asthma care, contributing to the development of new hotspots in areas that previously had better coverage. Also, Florida’s rural areas, such as those in the Panhandle and parts of central Florida, often lack pediatric asthma specialists, and even primary care providers may be scarce, contributing to poorly managed asthma in children. In Florida, asthma impacts rural as well as urban communities. (Florida Asthma Coalition, 2023) (Florida Department of Health, 2023) 

 

Second, in 2023 and 2024, several regions in Florida, especially rural and semi-urban areas, have experienced a decline in access to pediatric pulmonology due to retirements, relocations, and other workforce issues. (Ramesh & Yu, 2023) (Noah, 2023) This loss of specialized care directly correlates with increased emergency room visits for asthma-related incidents. (Patel, 2023) These losses disproportionately affect lower-income communities, where alternative healthcare options are scarce. (Mann, 2023) (Orr, et al., 2024) When families lack access to regular asthma checkups, prescriptions, or preventive education, asthma management declines, contributing to these areas becoming new hotspots. (Mann, 2023) 

 

Lastly, Florida’s high humidity, warm climate, and regular rainfall contribute to high levels of indoor and outdoor allergens. (US EPA, 2023) (Ziska, et al., 2023) Combined with high levels of air pollution in urban areas like Miami and Tampa, these environmental factors are significant contributors to asthma exacerbations. (Portnoy, 2023) The effects of hurricanes and flooding also cannot be overlooked. Post-hurricane mold and infrastructure damage contribute to worsening asthma conditions in affected regions, particularly when healthcare services are disrupted. (Adams, et al., 2023) (Morgan, 2024) Housing conditions in post-hurricane-hit areas will experience dramatic decreases in air quality if rendition is not economically feasible. (Morgan, 2024)

 
Virtual First Care

Virtual First Care (V1C) is medical care for individuals or a community accessed through digital interactions where possible, guided by a clinician, and integrated into a person’s everyday life. The name originates from the Digital Medical Society, DiME, who advocates for the utilization of the latest remote technologies and delivery of digital care. V1C companies use a fit-for-purpose selection of components that seamlessly combine into holistic care plans tailored to individual needs and preferences, enabling a truly patient-centered approach to healthcare. 

To be effective at delivering cutting edge care to a remote patient, V1C requires a complete redesign of the existing healthcare delivery workflows to incorporate multiple stakeholder groups: physicians, remote patient monitoring vendors, patients, payers and technical staff. Unlike brick and mortar practices, Virtual First Care requires a high level of technology acumen, stakeholder technology training and support, additional supply chain logistics challenges, and maintenance of technology integrations for remote data collection, testing, analysis, testing, and treatment. (Patel & Raphael, 2023)

 
V1C & PREDICT: as Asthma Solutions.

To enhance the accessibility to pediatric specialty care, Access Pediatric developed PREDICT, a care delivery model designed to enable remote pediatric specialty care delivery. While the COVID-19 pandemic has led to a rise in pediatric telehealth services, these services are still restricted to specific subspecialty care since they lack the necessary tools for diagnosis and patient monitoring, such as stethoscopes. (Williams, et al., 2021) More advanced workflows in supply chain logistics and electronic health records must be integrated to realize the benefits of remote care delivery. (Olson, et al., 2018) The best V1C models integrate Electronic Health Records (EHR) software with wearable technologies for reliable, remote patient monitoring, evaluation, and diagnostics. The non-VIC telehealth models have been rarely utilized for caring for pediatric asthma, likely because pulmonary functional tests can only be performed in hospital settings without remote device integrations.

 
Status Quo of Pediatric Telehealth Providers

Several telehealth-only services offered to pediatric patients, such as Teladoc, MDLive, and Amwell, use their own platforms. Other incumbent physician groups and hospitals with a brick-and-mortar practice use telehealth platforms provided by their Electronic Health Records EHR vendors such as Epic, Cerner, and Athena Health. These services adopt mobile apps and web platforms that offer live audio & video-based telehealth access to doctors for non-emergency issues, and scheduled appointments for various types of care. However, the existing services mostly focus on adult primary & urgent care, and mental health via video call, with limited pediatric urgent & specialty care. In addition, those services are not integrated with the necessary tools to allow physical evaluation such as auscultation, and diagnostic tests such as spirometry. TytoCare, a portable medical device manufacturer, provides a telehealth platform. However, this platform is exclusively compatible with Tytocare devices and does not integrate with all (EHR) systems. Currently, there is not a single device manufacturer that produces all the necessary devices for telehealth and remote monitoring in pediatric pulmonology specialty care. As a result, there is no platform or care delivery model, similar to PREDICT, capable of providing comprehensive pediatric pulmonology care using remote sensing and wearable devices. A previous study evaluated the parents’ perception of pediatric telemedicine services, which reported over 86% overall satisfaction. (Ray, et al., 2017) However, a recent survey conducted for parents of Acute Pediatric Respiratory Tract Infections (APRTI) showed that less than 50% of respondents expected a good quality of care via commercial telemedicine services. (Burns, et al., 2024) The traditional telehealth model is falling out of popularity as workflows were never properly modified. Parents, again, are generally using telemedicine to complement rather than replace in-person visits. (Ray, et al., 2017) The same study by Burns also indicated that less than 70% of clinical examinations were completed via telemedicine and only 30% of patients completed the requested vital report using non-integrated technologies. (Ray, et al., 2017) These previous studies collectively suggest: 1) the importance of understanding the parents’ and providers’ satisfaction and perception of pediatric telemedicine, 2) the limited access to pediatric specialty services, and 3) the suboptimal efficacy of the current outcomes of pediatric telemedicine. (Dorsey & Topol, 2016) (Olson, 2018) Without rethinking the workflows, human resources requirements and more technically oriented staffing responsibilities, the suggestions will be impossible to implement.

 
Conclusion

Virtual First Care has the potential to drastically reduce the incidence of asthma, particularly in areas like Florida, where pediatric pulmonology care is increasingly scarce and rapid demographic shifts from natural disasters and immigration compound access issues leading to marginalized population pockets. By offering a dynamic, scalable, and flexible healthcare delivery solution, V1C can transcend geographic limitations and provide consistent, high-quality care to children regardless of their location. Through V1C platforms, which seamlessly integrate wearable technology and remote diagnostic tools such as FDA-approved portable medical devices, pediatric specialty care can move beyond the constraints of hospital settings. This approach addresses current telehealth limitations by offering remote monitoring capabilities for asthma, a condition that often requires continuous observation and periodic diagnostic testing, such as pulmonary function tests. 

V1C’s success, particularly in addressing pediatric asthma care, hinges on reimagining healthcare delivery workflows to accommodate a range of stakeholders, including physicians, patients, payers, and technical support teams. Unlike traditional brick-and-mortar care models, V1C requires robust technological infrastructure, proper training, and dedicated support for all parties involved. By focusing on holistic care plans tailored to individual patients, V1C platforms can fill crucial gaps in telehealth services, providing the necessary tools to assess, monitor, and treat pediatric asthma remotely—something that has been historically difficult due to a lack of integrated tools like stethoscopes and spirometers in current telemedicine platforms. 

Moreover, studies show that while parents generally appreciate telemedicine, they still encounter limitations when it comes to specialty care. V1C aims to address these gaps by ensuring that the clinical examination diagnostics, and treatment processes are not compromised in a virtual setting. By empowering parents and healthcare providers with reliable tools and platforms for pediatric asthma care, V1C will not only enhance accessibility, but also improve the overall perception and efficacy of telemedicine. 

Ultimately, the deployment of V1C solutions such as PREDICT creates an innovative healthcare model that not only addresses the critical shortage of pediatric pulmonology specialists, but also has the potential to reduce asthma incidence and improve outcomes by leveraging remote monitoring and treatment technologies. As the healthcare landscape continues to evolve, Access Pediatrics is poised to lead the way in delivering comprehensive, patient-centered care with no geographic limitations, making pediatric specialty services more accessible, efficient, and effective.

 
 
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