Schools’ use of telehealth services expanded during the pandemic, and emerging research suggests it could help reduce chronic absenteeism.
Researchers from Duke University and the University of North Carolina-Chapel Hill tracked student absenteeism in three rural school districts—McDowell, Mitchell, and Yancey County Schools—in North Carolina as the nonprofit Center for Rural Health Innovation rolled out 22 school-based telehealth clinics, serving students, from 2011-12 to 2017-18. Through the clinics, school nurses partnered with physicians via live video appointments to help students with both physical and mental health issues. The doctors could review test results and call in prescriptions.
Before implementing telehealth clinics, the schools chosen for the program had higher rates of chronic absenteeism than demographically matched schools, 3.8 percentage points versus 1.9 percentage points, and their students missed more days of school on average, 1.18 days a year versus .98 days in the comparison schools.
After telemedicine was implemented, the researchers found that students in grades 3-8 who had access to telemedicine at school missed on average 10 percent fewer days of school (.8 days in a typical school year) and were 29 percent less likely to become chronically absent, than before the schools implemented telehealth. In practice, that meant students who used the telehealth clinics missed on average 20 fewer days of school than they would have if the telemedicine had not been available. Prior studies have found telemedicine can be particularly useful in monitoring and treating some chronic diseases such as asthma, which often contributes to chronic school absenteeism.
“The use of telemedicine in schools has really grown, and the ways schools use telemedicine have grown during the pandemic,” said Sarah Komisarow, the lead author of the study and an assistant professor in public policy and economics at Duke University. “This really layers over the existing role of the school nurse,” she added. “Thoughtfully bringing this sort of nonprofit capacity into schools is key to making this work. And the evidence says that this really helps students miss less school.”
Access to telemedicine seemed particularly helpful for boys, who also had higher initial absenteeism than girls. Komisarow said it’s not clear why, but noted that boys in the study were more likely to have asthma.
The study did not break down the specific kinds of care the telehealth doctors provided, but Komisarow said improved school attendance likely was the result of both more frequent preventative care and quicker responses to illnesses and outbreaks.
“Part of the reason care in the school makes sense is that ... if you have to get picked up from school, you’re not coming back that day,” said Amanda Martin, the executive director of the Center for Rural Health Innovation, which developed the school telemedicine initiative, in an online discussion of the program. Martin noted that more than 86 percent of telehealth visits resulted in the student staying in school after the appointment. Many students who had to be sent home for infectious diseases were able to return to school the next day.
“If a child presents at the nurse’s office, straight off the bus, and already feeling poorly [because of] strep throat or their pink-eye—which would otherwise get them ejected from school appropriately—if we are able to diagnose that at 8 a.m. via telehealth from the school nurse’s office, and the parent gets there promptly to pick them up and get them the first dose of an antibiotic, they can come back to school the next day,” Martin said. By contrast, students who are simply sent home sick may take a few days to get diagnosed, treated, and deemed safe to return to class, she said.
The Duke study did not include school years during the pandemic. However, a separate study by the National Institutes of Health found that school-based telehealth clinics could help schools respond to infectious disease outbreaks through faster testing and contact tracing.
While telemedicine access was not associated with improved math or reading scores, the study found students in schools using telehealth services were also 2 percentage points more likely to at least participate in standardized testing.
While the current study focused on rural schools, Komisarow said, “the results are really promising that this model could work in many settings, because students deal with chronic absenteeism for health-related reasons in rural settings, in urban settings, in suburban settings. And so, I think there’s a lot more potential here that could be explored.”