Uptake and effectiveness of a Virtual Model of Antenatal Asthma Care (VMAC) compared to a face-to-face model of care: a randomised controlled tele-trial

<bold>Background:</bold> Access, availability, and uptake of optimal asthma management are limited in maternity. <bold>Objective:</bold> To evaluate the uptake and effectiveness of a virtual model of antenatal asthma care vs. a face-to-face model of care. <bold>Methods:</bold> This parallel-group, assessor-blinded tele-trial recruited 200 pregnant women (mean age 29.8±5.4) with asthma from the antenatal clinics of John Hunter Hospital, Australia. All study procedures were completed over the phone. Both models of care consisted of the same structured asthma assessments, two education sessions and treatments delivered by a nurse educator and a respiratory physician, and auxiliary digital support such as text messages, written education materials and a smartphone App. Participants were randomised to receive asthma care via a virtual platform (VMAC) or face-to-face consultations. The primary outcome was the uptake of allocated treatment, and the secondary outcome was controlled asthma (ACQ5≤0.75), with follow-up conducted around the due date. <bold>Results:</bold> The uptake was significantly higher in the VMAC arm compared to the face-to-face arm (78% vs 66%; OR 1.96; CI 1.02-3.73; p=0.042). At follow-up (N=137), 79% achieved well-controlled asthma, and 84% rated the received intervention as very good/good, with no difference between groups (p>0.05). The most preferred auxiliary support was text messages (58%), followed by education materials (45%) and the App (21%). <bold>Conclusion:</bold> The virtual model significantly improved uptake without compromising efficacy. The two-visit nurse educator and physician asthma care programme was highly effective at improving asthma control during pregnancy.