Transcript
Announcer
Welcome to ReachMD.
This medical industry feature, titled “Engaging Patients and Caregivers About Digital Therapeutics,” is sponsored by Otsuka.
Here’s your host, Dr. Charles Turck.
Dr. Turck
This is ReachMD, and I’m Dr. Charles Turck.
Guiding patients and caregivers through the fast-moving landscape of digital therapeutics can be a challenging but worthwhile part of providing effective and accessible care. So, joining us to discuss how to partner with patients and caregivers around this relatively new treatment option is Dr. Maggie Emerson, who’s a Clinical Associate Professor at the University of Nebraska Medical Center College of Nursing in Omaha. Dr. Emerson, welcome to the program.
Dr. Emerson
Thank you so much for having me today.
Dr. Turck
Digital therapeutics are becoming a treatment option in many areas of healthcare but may provide challenges for patients and caregivers. So, Dr. Emerson, what are some of the barriers that patients might face when thinking about starting digital therapeutic treatment?
Dr. Emerson
Well, first off, I think individuals generally fall into two categories when it comes to barriers. So, the first group includes those who simply aren't interested in using technology at all. And then you have the second group, consisting of those who may be interested but have concerns about their skills and comfort level with the technology.1 And digital tools can be intimidating depending on your skillset, so individuals often have to ask themselves, ‘Is this something I can use, and do I have the necessary tools?’ I hear these concerns from patients quite frequently.
So, another barrier that can affect anyone is just the general access to technology. Access can vary based on several factors, including things like1:
- The availability of resources like Wi-Fi, which can be essential for the technology to function,
- And then compatibility issues, such as the need for a specific device or operating system to use the tool,
- And then connectivity, ensuring that the device will work effectively in their location, whether that be in a rural setting or in an urban setting
- And then another potential limitation that affects access is the availability of the technology in a variety of languages
So unfortunately, not all digital tools are available in a wide range of languages, which clearly creates some barriers. So for instance, some apps are only available in English or in Spanish. While we are seeing more apps being offered in multiple languages, this availability is still just not consistent across the board.1
In general, when we are using digital therapeutics within that patient and provider relationship, it’s important to emphasize that these tools are not meant to replace that human connection. Digital therapeutics are typically designed to complement that existing relationship, and really not substitute for it. So, patients may worry about losing that personal interaction when using the technology, so it’s really crucial to address this concern upfront with them. The primary goal of the digital therapeutic should be to enhance and support that relationship, and definitely not diminish it.1
Dr. Turck
Now in your clinical practice, how do you approach conversations with patients and caregivers about using a digital therapeutic, knowing that any or all these barriers might be present?
Dr. Emerson
So first and foremost, it’s important to gauge whether that patient has any interest in using a digital therapeutic. So, if they don’t, it’s crucial to understand why. As I mentioned earlier, some patients simply have no desire to use technology. And so for those patients, a digital therapeutic might actually hinder their care rather than enhance it.2
And then, there are those who might be interested but are concerned about whether they have the necessary skills. So, it’s important to recognize that this is a different situation—they have the interest, but they just need some support in developing those skills.3
So, in our work with the providers and patients, we've noticed a disconnect sometimes where the providers often assume that the patients may not be interested or may not have access to the necessary technology based on their life circumstances.3 However, often this is not the case. Smartphones, for example, are widely accessible across many underserved populations, making digital therapeutics a viable option for a broad range of patients.4 And it’s crucial that we don’t make inaccurate assumptions about those who might benefit from these tools.
Another thing to also highlight is to take the time to understand the specific benefits that the technology might offer for the patient. So as a provider, I encourage my colleagues to explore and identify the potential benefits that can enhance the patient’s care and be customized to meet their individual needs.3,5
Additionally, discuss those barriers reviewed up front with patients and their caregivers, so that we can really try to get ahead of those potential issues. This might include whether the digital therapeutic requires reliable connectivity or might be affected by issues like variable Wi-Fi access or outdated routers. Before discussing these tools with patients and their caregivers, ensure that you understand not only how the technology functions in the clinic, but also how it will perform when they’re at home, and what their experience will be like.3,5
Dr. Turck
Now when you’re having these conversations at the clinical visit, Dr. Emerson, do you find that patients often have questions or misperceptions around digital therapeutics that you have to address?
Dr. Emerson
I think more people are becoming much more aware of privacy and security concerns. And because of this, whenever I consider using a digital therapeutic or any technology for that sake, I make sure to understand the privacy and security policies. Our top priority really is protecting that patient data. So patients will definitely have questions about this, and as the provider, it really is my responsibility to ensure I fully understand how their information is being used, how it’s being protected, just like I would with any other type of technology-related device that we might consider using.3
And then, another important aspect is to consider how the technology will be integrated into their care. It's not just about signing them up for something, and then never discussing it again. When I meet with the patient, I really focus on how this tool will provide additional insights into their care. And then also making sure that I’m not overwhelming them with too much information. 6
Some apps will provide data directly to the provider, but for apps that don’t, the patient can provide an opportunity to give feedback on their experience and working with the app, which can be incredibly valuable. So building that rapport with the patients and understanding how specific features of the app can be beneficial with them is crucial. 6
And it’s key that patients understand that using the app is a continuing part of their care, as it can really help us to see what happens in between appointments, and that we’ll use the information gathered from the app to help guide our discussions and decisions during our next visits together. So understanding how the data that’s collected will contribute to that therapeutic relationship is imperative because the goal is not just to send someone off without further engagement.6
It's sort of like assigning homework but then never checking it once it gets turned in. If however, after we assign the homework, we then review it together to see what worked, what didn’t, we can identify what's truly effective, and then evaluate the success of that digital therapeutic. We can also reinforce the benefits that it might be providing and promote engagement.
Dr. Turck
For those just tuning in, you’re listening to ReachMD.
I’m Dr. Charles Turck, and today I’m speaking with Dr. Maggie Emerson about partnering with patients and caregivers on digital therapeutics.
So, Dr. Emerson, once you’ve come to an agreement with the patient that a digital therapeutic would be of potential benefit, how do you counsel them on the therapy?
Dr. Emerson
So, the first step is to discuss the specific treatment we're considering. So, we begin with an orientation on the digital therapeutic that we're planning to use. This helps us really to assess the patient's skills and identify any gaps that could affect their use of the tool. So, understanding this helps us to determine if additional support might be needed and what areas of support that we should really focus on. Sometimes, it might involve bringing in others to assist in helping the patient develop those necessary skills.3
Next, in our practice, we guide the patient through the workflow for the digital therapeutic. So, during the initial sessions, we focus on prescribing the product, ensuring that the patient knows how to use it, and really taking the time to explain how the information gathered will be integrated into their actual care with us. I find that although it’s crucial to not overwhelm the patient with information, we also want to avoid simply sending them off with the assumption that they are fully understanding everything we’ve covered because there’s a lot that we cover. So in my experience, if we don't cover these aspects thoroughly, patients may become frustrated or disengaged, making it harder for them to really benefit from that digital therapeutic.
Dr. Turck
And as a follow-up, are there any techniques you use to keep patients motivated and engaged?
Dr. Emerson
Yes, that is another great question. So we know that digital engagement tools often not sustainable unless they're integrated into that provider-patient relationship. Regularly meeting with the patients is essential to not only assess whether they're using the tools, but also how they're using them. And then identify any challenges that they might be facing. So, we can work together to address those challenges. And it's important to establish with the patient and those involved in their care that reviewing their use of these tools will be a very much routine part of what we’re doing in our clinical visits. 7
So, I think discussing this and setting this up with the workflow within that clinic system, helps us to create a sense of meaning and value for the patient, which ultimately can help motivate them and continue to using that prescribed digital therapeutic. And I’ve found this process really plays a key role in establishing, and strengthening that provider-patient relationship.
Dr. Turck
Now as we near the end of our program today, Dr. Emerson, are there any additional resources on digital therapeutics that you’d like to recommend to patients and their caregivers?
Dr. Emerson
Given the many steps involved, we've found that digital navigators can be an invaluable resource. They provide support and offer information to patients and caregivers. They can also assist healthcare providers by developing sort of a curated list of library of apps that might be integrated into a patient’s treatment plan.5,7
Importantly, digital navigators can also help us to summarize some of the data that we’re collecting from dashboards or from the apps themselves that the patient has been using, which also allows us to better understand what’s really happening in between those patient appointments.5,7
There’s also a wide variety of app evaluation resources that are out there. So, if a patient presents you with a digital tool that they’re interested in, these resources can really help you assess whether it's appropriate for your patient’s care. The app evaluation resources can offer guidance on some of the things that we talked about earlier, such as examining safety, and privacy, and other key factors related to that technology. And so, while there are a lot of tools that already exist to help us navigate this space, it's important to remember that the digital therapeutic landscape is really changing and constantly evolving. So I would imagine there will be more resources that will likely emerge as we continue in this space that become more integrated into our practice.3
Dr. Turck
Those are great points to end on, and I want to thank my guest, Dr. Maggie Emerson, for sharing her expertise on connecting patients and caregivers with digital therapeutics.
Dr. Emerson, it was great speaking with you today.
Dr. Emerson
Thank you so much. It’s been a pleasure.
Dr. Turck
I’m Dr. Charles Turck.
Announcer
This medical industry feature was sponsored by Otsuka. If you missed any part of this discussion, visit Industry Features on ReachMD.com, where you can Be Part of the Knowledge.
References:
- Whitelaw S, Pellegrini D, Mamas M, et al. Barriers and facilitators of the uptake of digital health technology in cardiovascular care: A systematic scoping review. Eur Heart J Digit Health. 2021;2:62-74.
- Raihan N, Cogburn M. StatPearls Publishing; 2024. Updated March 6, 2023. https://www.ncbi.nlm.nih.gov/books/NBK556005/
- American Psychiatric Association. Accessed July 3, 2024. https://www.psychiatry.org/psychiatrists/practice/mental-health-apps/the-app-evaluation-model
- Silver L. Smartphone ownership is growing rapidly around the world but not always equally. Pew Research Center. February 5, 2019. Accessed August 7, 2024. https://www.pewresearch.org/global/2019/02/05/smartphone-ownership-is-growing-rapidly-around-the-world-but-not-always-equally
- King D, Emerson M, Tartaglia J, Nanda G, Tatro N. Methods for navigating the mobile mental health app landscape for clinical use. Curr Treat Options Psychiatry. 2023;10:72-86.
- Heath S. How digital literacy drives mhealth patient engagement. Patient EngagementHIT. January 27, 2017. Accessed August 7, 2024. https://web.archive.org/web/20170605045916/http://patientengagementhit.com:80/news/how-digital-health-literacy-drives-mhealth-patient-engagement
- Wisniewski H, Gorrindo T, Rauseo-Ricupero N, Hilty D, Torous J. The role of digital navigators in promoting clinical care and technology integration into practice. Digit Biomark. 2020;4(Suppl 1):119-135.
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