American Journal of Respiratory and Critical Care Medicine 2017 — May 2017 —
Rationale: Digital health interventions have demonstrated positive impacts on clinical outcomes in asthma, but data on their impact in chronic obstructive pulmonary disease (COPD), and among older populations, have been limited. We aimed to assess the feasibility and clinical impact of a digital health intervention in a Medicare population with COPD or asthma.
Methods: Participants were enrolled in a single arm, pre-post digital health pilot study at the JenCare clinic in Louisville, Kentucky. Participants were eligible with a diagnosis of asthma or COPD and a compatible short-acting beta agonist (SABA) medication. Participants recived a Bluetooth-enabled inhaler sensor, which tracked the date, time, and frequency of medication use for 12 months. Participants without a smartphone were offered a wireless hub for data transmission. Participants received access to web-based dashboards and emails that provided information about their disease status and guidelines-based education. JenCare staff monitored medication use through a web-based dashboard to inform care and identify signals of acute worsening. To assess feasibility, we evaluated the number of participants that enrolled and synced a sensor to initiate data transmission, and the duration of active participation. To assess impact on clinical outcomes, we evaluated the impact on SABA use and symptom-free days at 6 months versus baseline.
Results: 236 participants were enrolled, including 198 with COPD and 38 with asthma. Of these participants, 222 (94%) synced a sensor to begin data transmission and 192 (81%) were active after 10 months.
Among asthma participants, 65% were 60 or older and 82% were female. Participants self-identified as 39% White and 58% Black. 95% trasmitted data via wireless hub. 82% were considered uncontrolled at enrollment as measured by the ACT. After 6 months, SABA use had decreased from 1.15 (first week) to 0.56 uses/person/day (last week), a significant decrease of 51.4% (p<0.05). Symptom-free days increased from 46% to 59%, a 28% improvement.
Among COPD participants, 78% were 60 or older and 66% were female. Participants self-identified as 53% White, 44% Black, and 3% other. 97% transmitted data via wireless hub. After 6 months, SABA use decreased from 1.53 (first week) to 0.74 uses/person/day (last week), a significant reduction of 51.7% (p<0.01).
Conclusion: A digital health intervention was feasible and effective among older, diverse Medicare population. Participants demonstrated high activation and retention rates, significantly reduced SABA use and more symptom free days.