A recent study looked at the benefits of digital health by tracking the use of SABAs to correlate hotspots of pollutants in the community. Using this data can lead to multiple policy changes for public health.
The logical conclusion on the issue of adherence is that at some point in the future, we will be able to track and measure when, where, and how a patient takes their medication. This may be all sensor based on some form of currently evolving technology or something we are still creating, but that data will be uploaded, shared, and utilized in patient care.
Now, the obvious conclusion to draw from this is that the implication for individual patient care will be huge, but what about the public health aspects? Can we see opioid utilization across the United States, and which populations may be harmed the most? Could we track rates of adherence to diabetes pharmacotherapy and cross-compare with the geographic region on what local aspects could be hampering adherence or therapy outcomes (eg, such as a lack of parks, high concentration of fast food, lack of care providers). This may sound far-fetched, but let me present to you the 'Air Louisville' study that is changing the way I think of tracking medication adherence beyond individual patient management.
The odds are that if you read my writing, you know about the smart inhalers I love to talk about. If you don't, one company called Propeller Health is US based, and they produce sensors that can be attached to an inhaler that can tell when someone uses it. Propeller has teamed up some public health researchers to investigate issues of asthma in Louisville, Kentucky.
The study was designed to determine the use of digital health as a means to improve asthma outcomes and engaging multiple partners for policymaking. A previous pilot using Propeller in Louisville had produced some impressive results, and this study was a larger roll-out. The study was aimed to determine hot spots in the surrounding areas of Louisville that triggered asthma symptoms and correlate with environmental causes. People were included in the study if they were a current resident and used a SABA. Actuations of their inhalers were tracked via Propellers sensors and recorded on a paired user smartphone, from which the data was then uploaded to a database. The study enrolled 497 people, ranging in age from 4-90 years old. Overall, a majority of patients were female, with 44% using a chronic asthma inhaler in addition to their SABA, and had their inhaler synced for 60 days or more.
The researchers, upon reviewing where and how often the participants were using their SABAs, were able to determine hotspots of areas where asthma symptoms increased. These included areas with high pollutant exposure from significant roadways and industrial zones. So what do you, as public health committee do to use this data to help improve the health of your community?
The researchers worked with the county to determine actions to take. This included revisions to current land development codes to increase tree coverage. It has been shown a higher concentration of trees can improve health by filtering out pollutants and may help enhance allergic sensitization to the populace. The recommendation on the creation of buffer zones between noted pollutant areas and regions with high concentrations of housing and schools was also considered. A follow-up project would then focus on providing warnings to the community on dangerous days or updates on when the air quality could trigger asthma issues.
This is an amazing study that I think pharmacists need to know about. It demonstrates how this data can be used to enhance care in the community. It is very similar to an earlier study this year that saw the use of smart thermometers predicting the spread of the flu in certain parts of the country. These studies open up different ways to potentially useful data for public health initiatives, and how it may turn into meaningful projects that can improve the health of our patients. It also reaffirms the benefit of digital health beyond just an individual patient. This technology could help reduce exacerbations and other negative outcomes in the long-run, which I think many will be paying more attention to in the future.
1. Barrett M, Combs V, Su JG, Henderson K, Tuffli M. AIR Louisville: Addressing asthma with technology, crowdsourcing, cross-Sector collaboration, and policy. Health Aff. (Millwood). 2018;37(4):525-534.