Improving health outcomes for vulnerable and underserved populations — those who may have limited access to healthcare services based on age, race, gender, ethnicity, socioeconomic status, language, distance or other factors — is an increasingly urgent issue and a top priority for the new U.S. administration.
Digital health companies, including Propeller, have potential to help many of these populations manage chronic conditions and have a higher quality of life. Yet, to date, the majority of digital health tools have not yet demonstrated substantial impact among high burden and underserved populations, often because they have not yet focused on them. And where work has begun, gaps in access and coverage of digital tools have been identified, which may lead to greater disparities in health outcomes for those who do not have access. In a recent article published in NPJ Digital Medicine, digital inclusion was proposed as an increasingly relevant social determinant of health.
In respiratory disease, morbidity and mortality disproportionately burden vulnerable and underserved populations with asthma and COPD. To address these important issues, we have been exploring our data and wanted to share early insights observed among Propeller users — starting with questions around the impact of age, insurance type and socioeconomic status on platform engagement and clinical outcomes. Here’s what we found.
Older Propeller users engage with digital health and have high adherence to digital treatment plans
As we examined our internal data on how people with asthma or COPD engage with the Propeller platform, a consistent trend emerged that surprised us at first.
Older patients, contrary to assumption, were more engaged than any other age cohort. Of the patients over the age of 50 who use Propeller on a monthly basis, one third of them engage with our mobile app on a daily basis — much higher than the average usage of health apps. This is an encouraging sign, as we sometimes hear from providers serving older adults that their patients won’t understand or be interested in using a smartphone app to manage their condition.
Another study1 — published in the Journal of Allergy and Clinical Immunology: In Practice — found that Propeller users over the age of 60 also had the highest controller medication adherence of any age cohort, which suggests that older patients can both engage with and benefit from digital health tools.
We’ve also seen positive data from Medicare patients without smartphones who use Propeller.
Instead of using a phone, these patients connected their inhaler sensors to LTE hubs they plugged in at home. Their sensors chimed when it was time to take a dose and sent data on controller and rescue medication use to the hubs, which then sent data to the patients’ clinicians. Over six months, this program maintained excellent patient retention (>80%) and engagement with the platform (>90%), and demonstrated promising clinical outcomes2.
Similar improvements in asthma outcomes were observed with Propeller regardless of income and education
Recently, 360 Propeller users consented to self-report their income and education in a survey to help us evaluate how the platform supports different groups. Of these adults, 60% had very poor asthma control at enrollment and stood to benefit from using Propeller.
When examining their outcomes stratified by income and education, we found similar trends.
Regardless of a participant’s income or education level, we saw similar improvements in the number of symptom-free days gained over the patients’ first 90 days of using Propeller, even if they started with different baselines. Additionally, we saw similar declines in rescue inhaler use over 90 days for all income and education levels. More research is needed across a larger and more diverse user sample to confirm this trend.
Digital health programs integrated with clinical care show promise for both seniors and children in underserved populations
Another important lesson we’ve learned about engaging underserved populations in a digital health program is that technology alone is not enough to overcome the unique barriers faced in this population.
To engage patients and improve outcomes, coupling a digital health tool with a care team experience can make a great difference.
One study2 with JenCare Senior Medical Center enrolled 190 adults with COPD, most of whom were dual-eligible (Medicare and Medicaid) patients. 81% were aged 60 or older, 45% were Black and 97% were hub users. Over 12 months, patients saw a 36-point increase in days without rescue use and a 63% reduction in rescue inhaler puffs per day.
This digital health intervention was successful not only because of technology, but because of the concurrent insights provided to physicians and respiratory therapists throughout the program, likely allowing them to make more informed decisions and engage patients in the management of their condition.
Similarly, a small, six-month study3 serving 21 predominantly Black, Medicaid-insured children found success by offering Propeller’s technology with a comprehensive school-based intervention including adherence coaching and provider video visits. The program also offered smartphones to all participants, removing the hardware barriers often reported in underserved populations. All patients completed the study and results indicated improvements in both symptoms and medication adherence, as well as fewer exacerbations and school absences.
Though we’ve made progress, we still have a lot of work to do to ensure that Propeller is accessible, usable and effective for many different types of patients. There are many broad barriers to digital health adoption to recognize and address. Recently, we presented these findings and hosted a panel discussion on the barriers to equitable digital care and how healthcare leaders, providers and policymakers should work in tandem to make progress.
The panel featured perspectives from experts with experience managing digital health interventions for underserved communities:
- Theresa Guilbert, MD, Pulmonologist and Director of the Asthma Center at Cincinnati Children’s Hospital
- Linda Hotchkiss, MD, Psychiatrist, Former Medical Director at Anthem, and Former Director of Clinics at Aurora University of Wisconsin Medical Group
- Andrey Ostrovksy, MD, Pediatrician at Children’s National Hospital and Former Chief Medical Officer at U.S. Medicaid
A major barrier the panel pointed out is the ambiguity of billing for the use of digital tools — as well as appropriate, standardized valuation of these tools to encourage provider adoption. You can hear more of what the panel had to say by watching a recording of the discussion here.
As a follow-up to the panel, the speakers also collaborated with Carlos Nunez, MD, Chief Medical Officer at ResMed, and Robert Jarrin, JD, Strategic Advisor to ResMed on a MobiHealthNews op-ed highlighting the need for improved incentive structures for remote patient monitoring.
Questions about our research on supporting underserved populations with asthma or COPD? Contact us at firstname.lastname@example.org.
1Anderson et al. (2020).
2Chen et al. (2019).
3Lin et al. (2020).