O2204: Association of Spanish language preference with asthma outcomes in an SMS-based telemedicine asthma specialist care intervention following an emergency department visit

Background: Language barriers are often associated with inferior patient outcomes. Technology such as SMS text messaging may provide accessible communication in a patient’s preferred language and presents an opportunity to lessen inequities in care. Prior studies have demonstrated telemedicine is an effective modality to improve asthma control. However, little is known about the effect of SMS-based telehealth on patient-centered outcomes in Spanish-preferring families. We aim to evaluate the effectiveness of SMS text-based intervention in reducing asthma outcome inequities among patients with Spanish-preferring families.

Methods: We performed a secondary analysis of data collected during a randomized clinical trial of Asynchronous Telemedicine Asthma Specialist Care (AT-ASC) among children ages 2-18 presenting to the Emergency Department (ED) for asthma care (June 2022 - June 2023). All participants were sent the following via SMS text: 1) an asthma severity survey assessment during their initial ED encounter; 2) an asthma severity assessment survey every three weeks following initial ED visit; 3) automated treatment feedback based on asthma severity survey results and self-reported medication adherence; and 4) pulmonologist assessment of survey responses and prescription of controller medications (intervention only). We compared language preference with sociodemographic and clinical characteristics at enrollment, as well as clinical and parent-centered outcomes captured 12 months post-ED visit using Fisher’s exact and Chi-square tests.

Results: Of 145 participants initially enrolled, 7 participants were excluded who did not primarily speak English or Spanish. Of 137 analyzed, 64% expressed English preference and 36% expressed Spanish preference. A higher frequency of Spanish-preferring parents reported an annual household income less than $50,000 (72% vs 92%) (p < 0.05). There were no significant differences between English-preferring and Spanish-preferring patients in asthma severity, asthma related ED visits, or oral steroid use in the 2 weeks prior to the intervention.

At 12-months following recruitment, 68 patients had continued follow-up. The intervention arm had 42 patients, of which 54% preferred English and 45% preferred Spanish. At 12 months following initial ED visit, asthma outcomes did not significantly differ between language preference groups in the intervention arm (all p ≥ 0.05) (table 1). At 12 months post-enrollment, more than 80% of all patients agreed that AT-ASC: meet a need, saves time, is flexible, and is effortless (table 2).

Conclusion: A bilingual, SMS-based AT-ASC is strongly endorsed by both English and Spanish preferring patients and appears not to perpetuate disparities in asthma outcomes or care amongst children of families with Spanish language preference. In this tertiary center’s population with limited financial resources, telehealth may improve access to care. Additionally, SMS text may provide an opportunity to provide equitable care given limited interpreter availability in most clinical settings. Further research is needed to assess the effectiveness of this intervention in communities with variable socioeconomic and linguistic diversity.