Transcript
Announcer
Welcome to ReachMD.
This medical industry feature, titled “The Evolution of Psychiatric Healthcare: Integrating Digital Therapeutics into Practice,” is sponsored by Otsuka.
Here’s your host, Dr. Charles Turck.
Dr. Turck
You’re listening to ReachMD, and I’m Dr. Charles Turck.
Digital therapeutics are a relatively new and intriguing treatment option in mental health care, but translating from a clinical trial to clinical practice can be challenging. So joining us to explore strategies for incorporating digital therapies into clinical practice are
Drs. Robert McCarron and Arwen Podesta. Dr. McCarron is a Professor in the Department of Psychiatry and Human Behavior as well as an Associate Dean of Continuing Medical Education, at the University of California, Irvine School of Medicine. Dr. McCarron, welcome to the program.
Dr. McCarron
It’s great to be here.
Dr. Turck
Also with us is Dr. Arwen Podesta, who’s a New Orleans private practice psychiatrist and the President of the Louisiana Psychiatric Medical Association. Dr. Podesta, thank you for joining us today.
Dr. Podesta
Thanks for having me.
Dr.Turck
Now we know that digital therapeutics are an exciting new tool in the psychiatric arsenal, but going from FDA authorization to patients accessing and using them in the real world is not an overnight process. Let’s start with you, Dr. McCarron. What are some of the common hurdles providers and patients face when considering the use of a digital therapeutic?
Dr. McCarron
Well, I think choice is an important one as there are several new products authorized by the FDA recently, most patients and clinicians aren’t well-versed on digital therapeutics just yet. So what I hear the most from my colleagues is which one do I select? Which one works, and which one's the best out of all of them? I think that's probably one of the biggest challenges, what to use and when.
How about you, Dr. Podesta?
Dr. Podesta
Agreed. I also think that for us as prescribers, we need the language first, how to think and talk about digital therapeutics.
Even before we gear up to use them, I think that trusting digital therapeutics is key, which is where I think the FDA authorization process makes the difference. Once we have some understanding of digital therapeutics, like any other treatment, we need to know when to use them and how to help patients use them successfully. And of course, the nuts and bolts of how to prescribe them and monitor their use is imperative.1,2
Also, many providers feel hampered because they don't have a team support team. So digital therapeutics can be a team extender or can be a prescriber extender. And I think that once physicians get used to that, it's going to be easier to incorporate and patients will start asking for it.1,2
Dr. Turck
And sticking with you, Dr. Podesta, what do you look for in a patient who suggested a digital therapeutic might be a good fit for them?
Dr. Podesta
So in my practice, I’ve found that digital therapeutics work really well in the highly motivated and engaged patients, in patients who have demonstrated understanding or interest in utilizing technology, in patients who currently have devices. Also, of course, the patient should speak the language in which the tool is available, which seems obvious but isn’t always the case. In addition, patients should have whatever access is needed to use the therapeutic, whether it's a device or Wi-Fi, things like that. There shouldn’t be uncertainty about whether the patient can consistently use the app when they leave the office.2
What are your thoughts, Dr. McCarron?
Dr. McCarron
I agree, and I believe we might even think more broadly—that this treatment modality is good for your patients who are struggling with some aspect of their mental health. I mention this because there are a lot of providers who don't use this modality for treatment and may be unfamiliar with these types of treatments in general. So they’re not introducing digital therapeutics as an option to their patients.1,2
For example, a digital therapeutic for depression or ADHD might likely be appropriate treatments for many patients with these particular conditions, but the practitioner must first be comfortable using those kinds of therapies to be able to offer them.1,2 So I would emphasize that a patient having the relevant condition is the starting point for considering this treatment modality. And really, if you treat any patients with depression or ADHD, you should educate yourself on digital therapeutics.
Dr. Turck
And as a follow-up to that, Dr. McCarron, are there any factors outside the patient themselves that may influence your decision to recommend a digital therapeutic?
Dr. McCarron
Well, if the patient has low access to other modes of treatment, a digital therapeutic may be a good option. Patients may exist in what are called treatment deserts where there are just not enough available providers for the patient to get individual therapy, cognitive behavioral therapy, and other types of therapies. And we’ve also got to consider that the patient must be able to financially afford the device and the app.2–4
Dr. Podesta, what do you think, do you agree?
Dr. Podesta
Absolutely. Those are all important things to look at.
I also want to address something that may cause providers to hesitate to reach for a digital therapeutic that isn’t dependent on the patient, and that’s the concept of data burden. Some providers may have the idea that all digital tools will require that the prescriber do more monitoring, more data inclusion that might not sync into their electronic health record system, and overall, just have a greater time burden without necessarily improving patient care. We all get that.5
Many providers already feel overloaded and are concerned about things like burnout. However, prescribers need to educate themselves on just what a specific digital therapeutic provides and requires before dismissing it as being too burdensome.5
Dr. Turck
That’s an interesting perspective on the potential for prescriber burden. Dr. Podesta, are there any benefits that digital therapeutics can offer to healthcare providers?
Dr. Podesta
Sure well, we all want better patient outcomes. That echoes back to the idea that if the patient has this diagnosis, what do we do with it? A digital therapeutic provides another option of treatment that may empower patients with increased treatment choice, increased access to evidence-based treatments, and access to treatments with a demonstrated safety profile. All of those things can improve the likelihood that patients will see benefits, which is the provider’s fundamental goal. In addition, as we talked about before, digital therapeutics can extend a provider’s therapeutic reach. So I think all of those are key.6
What have you noted, Dr. McCarron?
Dr. McCarron
I like what you’ve said here, and I want to get back to an idea you brought up earlier about digital therapeutics as a team extender. The word extender has had a negative connotation in some spaces when using it to describe other types of providers, but in this case, it can be a real win for a busy provider. With digital therapeutics, extension of care connotates that we're helping the busy provider with their patient as an add-on, or to be an additional appendage to what the provider's already trying to do but has limited time to accomplish.6
Dr. Turck
For those just tuning in, you’re listening to ReachMD. I’m Dr. Charles Turck, and today I’m speaking with Dr. Robert McCarron and Dr. Arwen Podesta about the integration of digital therapeutics in mental health care.
So we’ve spoken about patient and provider considerations in using digital therapeutics in clinical practice. But now let’s shift over to the next steps. Once you’ve determined that your patient is a good candidate for this modality, how do you proceed? Dr. McCarron, let’s hear from you first.
Dr. McCarron
Let’s start with introducing the patient to the idea of digital treatment for their mental health issue, that’s really the first conversation. So, it’s helpful to anticipate what their questions will be, such as what is this treatment and how does it work? Importantly, spending time helping the patient understand what the potential advantages are, and really what are the unique advantages in this case? We’ve talked about some of those already, and patients should be aware of all the ways they may benefit. A digital therapeutic may offer benefits that other treatment modalities cannot and that’s important to call out.7
What would you like to add on this point Dr. Podesta?
Dr. Podesta
You know, I think that even before that conversation, you might want to think about ways to introduce digital therapeutics to your patients. So if you're an in-person clinic—having pamphlets and flyers around, even having posters up in the clinic can get people thinking about whether that might be an option that they might want to consider. And that takes us back to prescribers being knowledgeable and prepared when patients do ask about the digital therapeutic.5
Having a digital link to send to patients to see a demonstration of the therapeutic is also a great start to get the patient onto the therapy. Also consider reviewing the literature, so that you’re able to provide some outcome studies and say, ‘This is what the study looked at so far, and I think you could probably see a similar outcome.’ In addition, digital therapeutics can have a very favorable safety profile. And that’s a tremendous benefit to share with the patients.5
Dr. Turck
And in your clinical experience, Dr. Podesta, how do you incorporate digital therapeutics into your overall treatment plan?
Dr. Podesta
Honestly, that's going to vary from clinic to clinic and from practice to practice. You know each group or individual prescriber really needs to set up their own protocols that they're comfortable with. It might be incorporating a check-in, having some automated emails that come from the prescriber, things that we do with all our treatments.
We have to think about what happens after we send a patient on their way with a new prescription, right? And everyone does it differently, and some patients may never start that new medicine or may never even pick that medicine up that we write, and we might not see them for three to six months, so we didn't know about it.
So how do you have better outcomes with your patients and create a protocol for that? I think it’s really individualized. I encourage prescribers to create their own protocol just like they would with any therapeutic, with any medication, or any other treatment device.
Dr. Turck
Now, Dr. McCarron, as with any therapy, patient engagement can be an issue. How does that apply to digital therapeutics, and how can healthcare providers help patients and caregivers utilize therapies consistently?
Dr. McCarron
The first thing that comes to mind for me is the patient’s level of motivation, which we assess through motivational interviewing. Are they pre-contemplative? Are they contemplative? Where are they on their treatment journey? Because the bottom line is if they're not motivated, then we must start at that level with them. We have to accept that they’re currently unmotivated and try to get them motivated over time as best we can. That’s why I think assessing the patient’s level of motivation is going to be important from the very start.8
Dr. Podesta, have you seen this in your own experience?
Dr. Podesta
Yeah, that’s a great point and it goes back to how we initially assess patients and decide which tool is best for which patient
If they're in pre-contemplation, do we write the prescription and now and let it sit, or do we consider them not a candidate at this time? And that's really provider-dependent. Maybe they're walking step-by-step with a patient, or maybe they're not going to see them in three months. Where do we sit?8
I also think that, just like everything else, incorporating a digital therapeutic into a treatment plan , if possible, could involve loved ones, supportive members of the family, or whoever is available in the patient's sphere.
Dr. Turck
As we come to a close, what resources would you recommend for healthcare providers interested in digital therapeutics, particularly in mental health, starting with you, Dr. Podesta?
Dr. Podesta
Well to start, both the Digital Therapeutic Alliance and the Digital Medicine Society are great sources of information on digital therapeutics. They have general education for the provider as well as app libraries of digital therapeutic tools.6,9
And the APA App Evaluation Model on the APA website also provides a comprehensive guideline on how to evaluate digital therapeutics, which can be really useful in such a dynamic treatment environment.5
Any others that you’d add, Dr. McCarron?
Dr. McCarron
Yes, PsychU is also a great place to get good information on digital therapeutics, specifically in mental health.10
Dr. Turck
Thank you both, those are great take-home points for our audience. So with those final thoughts in mind, I want to thank my guests, Dr. Robert McCarron and Dr. Arwen Podesta, for sharing their valuable insights on the practical applications and benefits of incorporating digital therapeutics in mental health care.
Dr. McCarron, Dr. Podesta, it was great speaking with you both today.
Dr. Podesta
Happy to be a part of this discussion.
Dr. McCarron
It was my pleasure.
Dr. Turck
I’m Dr. Charles Turck.
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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:
- Secker-Johnson R, et al. February 2, 2022. Accessed June 21, 2023. https://www.zs.com/insights/barriers-to-broad-dtx-adoption-and-ways-to-overcome.
- 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.
- Lovett L. October 26, 2022. Accessed July 5, 2024. https://bhbusiness.com/2022/10/26/clarity-on-digital-therapeutics-reimbursement-could-lead-to-more-behavioral-health-adoption/
- Managed Healthcare Executive. May 19, 2023. Accessed July 5, 2024. https://www.managedhealthcareexecutive.com/view/reimbursement-challenges-associated-with-pdts
- American Psychiatric Association. Accessed July 3, 2024. https://www.psychiatry.org/psychiatrists/practice/mental-health-apps/the-app-evaluation-model
- Digital Therapeutics Alliance. Accessed July 5, 2024. https://dtxalliance.org/about-dta/
- Duerr H. Exploring DTx for clinical care. Psychiatric Times. 2022;39:14-15.
- Raihan N, Cogburn M. StatPearls Publishing; 2024. Updated March 6, 2023. Accessed July 3, 2024. https://www.ncbi.nlm.nih.gov/books/NBK556005/
- Digital Medicine Society. Accessed July 5, 2024. https://dimesociety.org/about-us/
- PsychU Digital Health. Accessed April 4, 2023. https://psychu.org/resource-library/e-health-and-technology/
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