Effectiveness of School-Based Telehealth Care in Urban and Rural Elementary Schools

Abstract

Objective. This study evaluated the quality and cost effectiveness of health care provided in urban and rural elementary school-based telehealth centers, using plain old telephone system (POTS) technology. Methods. A telehealth school-based model was developed that used a full-time school nurse, half-time mental-health consultant, linked pediatric practice, and linked child psychiatrist via POTS with an electronic stethoscope; ears, nose, and throat endoscope; and otoscope. One rural and 1 urban center were evaluated. Providers, nurses, children, and parents completed satisfaction questionnaires. Providers and nurses also evaluated how well telemedicine supported their clinical decision making. Parents were asked how use of the center affected them financially and at work. Results. Of the combined 3461 visits to school nurses at both centers, 4.3% resulted in 150 telehealth consultations referrals; 142 (95%) were completed during the 2-year project. The most common teleconsult diagnoses were otitis media, pharyngitis, dermatitis, and upper respiratory infections. Provider, nurse, child, and parent satisfaction all were high. Providers’ and nurses’ decision confidence scores ranged from a low of 4 to a high of 4.8 on a 5-point scale. Average family savings per encounter were 3.4 hours of work time ($43) and $177 in emergency department or $54 in physician costs. Including travel, savings for families ranged from $101 to $224 per encounter. Thirteen children received telepsychiatric evaluations resulting in diagnoses of depression and attention-deficit/hyperactivity, anxiety, and conduct disorders. Conclusions. Telehealth technology was effective in delivering pediatric acute care to children in these schools. Pediatric providers, nurses, parents, and children reported primary care school-based telehealth as an acceptable alternative to traditional health care delivery systems. The POTS-based technology helps to make this telehealth service a cost-effective alternative for improving access to primary and psychiatric health care for underserved children.