Engagement and outcomes of virtual antenatal asthma care: a randomised controlled tele-trial

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Background Access, availability and engagement of optimal asthma management are limited in maternity care. This study evaluated the engagement and outcomes of a virtual model of antenatal asthma care compared to a face-to-face model. Methods This parallel-group, assessor-blinded tele-trial recruited 200 pregnant women (mean age± sd 29.8±5.4 years) with asthma from the antenatal clinics of John Hunter Hospital, Australia, and randomised them to receive asthma care via a virtual platform or face-to-face consultation. Both models of care consisted of the same structured asthma assessments, two education sessions and auxiliary digital support such as text messages, education materials and a smartphone application (App). The primary and secondary outcomes were the engagement with the allocated treatment and asthma control (assessed using a 5-item asthma control questionnaire), respectively. Qualitative interviews explored the acceptability of both models of care in a subgroup of 30 participants. Results Significantly more patients engaged with virtual asthma care than face-to-face care (78% versus 66%; OR 1.96, CI 1.02–3.73, p=0.042). At follow-up, asthma control improved significantly in both groups (mean improvement: virtual 0.77±0.94, p<0.001; face-to-face 0.64±0.90, p<0.001) with no statistically significant difference between groups (p>0.05). The most preferred auxiliary support was text messages (58%), followed by education materials (45%) and the App (21%). The qualitative interviews supported the quantitative findings and highlighted the virtual care model's flexibility. Conclusion A virtual model of antenatal asthma care significantly improved the engagement of pregnant women with the programme compared to a face-to-face model of care, and both models of care demonstrated clinical effectiveness.