As with many health conditions, disparities between high- and low-income patients with asthma begin at a very young age. Children with asthma in low-income areas experience significantly greater healthcare utilization than children in high-income areas. This stark imbalance sets a harmful precedent and continues to put lower-income patients at a disadvantage throughout their lives.
New forms of interventions are needed if we’re going to successfully provide care and improve outcomes for lower-income children with asthma. Dr. Theresa Guilbert, a pediatric pulmonologist and director of the Asthma Center at Cincinnati Children’s Hospital, works closely on this issue.
She and her team recently completed a first-of-its-kind study, which combined telehealth, in-person visits and Propeller’s digital health platform to help economically disadvantaged students in Cincinnati take control of their asthma. Students received Propeller sensors for their inhalers and used our smartphone app to manage their medication regimen. They were then able to discuss concerns, like barriers to adherence, with healthcare providers during telehealth and in-person visits at their school’s clinic.
The study’s outcomes are promising. In six months, the students improved their controller medication adherence by up to 46% and experienced no emergency department visits or hospitalizations — a significant improvement over baseline.
We recently got a chance to catch up with Dr. Guilbert about the results of the study and what’s next for her work in this area. Our conversation unfolds, lightly edited, below.
Propeller: What are the barriers to effective asthma care that exist for children in low-income environments?
Dr. Guilbert: Many of the children have challenging home environments with rodents, pests and mold, as well as increased exposure to pollution and violence. They also experience barriers with transportation to the clinic and obtaining medications.
What is unique about treating adolescents with asthma? What do you recommend for clinicians struggling to increase adherence among an adolescent population?
Adolescence is a time of independence, and any child with a chronic disease may choose to not take their medications regularly as a form of rebellion. This is also complicated by the fact that developmentally, adolescents can feel invincible. My recommendation is to give the adolescent choices on medication plans and encourage them by finding an activity that is important to them that is also impacted by poor asthma control, like sports or a club at school.
What inspired the school-based care delivery model used for this study?
We saw a high rate of no-shows to clinic appointments in this economically disadvantaged population, leading to poor asthma outcomes. We had a partnership with the Cincinnati Health Department school-based health clinics and saw it as an opportunity to do a community-based study.
It’s interesting to see that outcomes improved as a result of the combination of digital health, telehealth visits and in-person self-management visits. How did the Propeller platform complement the care visits?
The Propeller platform allowed objective measurement of rescue and controller medication use which allow the health psychologist to conduct personalized self-management skill training.
Retention in the study was 100%, and satisfaction scores were very high as well. Why do you think the program had such a high level of retention, engagement and satisfaction?
We conducted it in a school setting, which was convenient for the families, and the adolescents enjoyed the technological aspects of the study. They also appreciated missing less school.
Many experts are worried that digital health technology is not accessible to disadvantaged populations who could benefit the most. Your study, however, shows that digital care may be a viable alternative to other care models that haven’t succeeded with low-income youth. Is digital health scalable among this population?
A recent PEW survey found that over 90% of inner-city residents and teens carry cell phones. If you can do a mobile phone-based platform that doesn’t use a lot of data, I think it is viable to scale digital care.
Despite the costs of technology and virtual care teams, your study suggests that virtual interventions may promote more cost savings than current models of care. Why is that?
It saves the family and adolescent in terms of transportation costs as well as time off work and school. It also reduces costly asthma outcomes, such as healthcare utilization, and saves the cost of a physician traveling to each community location.
What’s next for you and the respiratory team at Cincinnati Children’s?
Future projects include the development of a telehealth clinic, which we plan to launch through the school-based health center.