Initial results of a study conducted by a Baltimore startup and healthcare institution point to a potential tool to address one of the city’s public health challenges.
Through the study with LifeBridge Health, Mount Vernon-based emocha applied its technology, which allows patients following a prescription to submit a video taking their medication, to pediatric asthma. Patients sent a video of themselves using a prescribed inhaler. Tracking nearly 1,000 daily check-ins, the early results of the study showed a reduced number of ER visits and fewer oral steroid prescriptions, which can be required when inhalers aren’t used or are used incorrectly.
emocha’s app and service is designed to reinforce and ultimately help patients stay with a treatment regimen. It is tackling a key issue in healthcare: Even after getting medication, many patients often don’t stick to their prescription plans. This measure is known in healthcare circles as medication adherence.
emocha is bringing technology to a practice called directly-observed therapy, in which a patient is watched taking the treatment. With emocha’s tools, a healthcare worker doesn’t need to be in the same room as a patient, and they don’t have to watch it live. When it comes to pediatric asthma, the nonadherence rate is between 30 and 70% in both adult and child patients.
The study with LifeBridge revealed one of the issues at the heart of this: Children who need to use an inhaler needed help using their inhaler correctly, and emocha CEO Sebastian Seigeur points out that the healthcare system is not really set up to show them how. The majority of patients exhibited at least one technique issue, according to emocha. Members of the company’s team were available to follow up to assist with technique, sending both instructions and video back.
With follow-up training, Seiguer said that the study showed that patients did “really, really well.”
20% of Baltimore city children have an asthma diagnosis — more than double the national average of about 9%.
“You can correct this behavior. Children are generally willing to learn and aren’t set in their ways, so you have this ability to make an immediate impact,” he said.
Along with being conducted in Baltimore, the study underlines an issue facing the the city, as well. According to an Abell Foundation report written by Johns Hopkins University School of Nursing doctoral candidate Sarah LaFave that was released in October, 20% of Baltimore city children have an asthma diagnosis. That is more than double the national average of about 9%.
ER visits for pediatric asthma in the city are also more than double the statewide rate.
Like many of Baltimore’s challenges, this stems from the city’s racial and socioeconomic disparities that result from systemic racism codified in policies over decades. The disease disproportionately affects children of color and those from low-income families, the study reports, as 87% of pediatric asthma ER visits in 2019 were for Black children. It has taken on another dimension in the pandemic, as asthma is among the comorbidities that is causing more acute symptoms of COVID-19.
“It’s not kids and families making poor decisions,” LaFave said. Instead, “it’s not having the support they need to do what they want for their health.”
The report calls for leadership and financial investment on coordinated response to asthma, pointing out that “every major program in the city that cares for children with asthma who are at high risk for uncontrolled symptoms is understaffed and under-resourced.”
“We have choices about what we prioritize for funding, for attention, for legislation, and until we decide that we really care about the fact that kids are going to emergency department, going to the hospital, they’re missing school and they don’t need to be,” LaFave said, “until we decide that’s urgent and really important for us — that’s not going to happen.”
It’s a problem that will require many different groups to come together to solve, and the study makes a series of recommendations. But one of those solutions that is proposed focuses on is directly observed therapy, which is the area where emocha focuses.
It’s also an area where there is ongoing work in the city. One effort, called Project BREATHE, is working to implement a program delivered by school nurses at Johns Hopkins’ Rales Health Center, and the University of Maryland also rolled out a Breathmobile to bring visits to schools.
One issue that could help, said LaFave, is ensuring school nurses are present. Many schools don’t have a full-time nurse, so LaFave advocates bringing in nurses in areas where there is a high prevalence of asthma.
“If they’re getting the support a few days a week, we do see that those habits and those access issues improve,” LaFave said.
emocha’s technology shows potential for a video-based approach that can be applied in a school setting, and it’s not too far a leap to see how it could prove important given the current reality of distance learning.
“We’ve shown not only does it work, but that we can deliver it remotely in an asynchronous manner,” Seiguer said.
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