Application of blended care as a mechanism of action in the construction of digital therapeutics

Netto, Antônio Valério

doi:10.31744/einstein_journal/2020md5640

Cited by 9 publications

(6 citation statements)

References 3 publications

(3 reference statements)

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“…Through therapist involvement in regular therapy sessions, clients are able to receive personalized care, discuss therapy content in depth, and be held accountable for homework completion. The digital materials help maintain fidelity to evidence-based practices, reinforce key concepts and skills outside of session, and facilitate rapid dissemination of therapeutic content in a scalable manner [14]. Blended care CBT (BC-CBT) integrates the benefits of both modalities and is a potentially cost-effective manner of delivering treatment [15].…”

Section: Introductionmentioning

confidence: 99%

Examining the Impact of Digital Components Across Different Phases of Treatment in a Blended Care Cognitive Behavioral Therapy Intervention for Depression and Anxiety: Pragmatic Retrospective Study

Wu¹,

Wickham²,

Chen³

et al. 2021

JMIR Form Res

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Background Depression and anxiety incur significant personal and societal costs. Effective psychotherapies exist, such as cognitive behavioral therapy (CBT); however, timely access to quality care is limited by myriad barriers. Blended care therapy models incorporate traditional face-to-face therapy with scalable, digital components of care, expanding the reach of evidence-based care. Objective The aim of this study is to determine the effectiveness of a blended care CBT program (BC-CBT) in real-world settings and examine the unique impacts of the (1) digital components of care (video lessons and digital exercises) and (2) phase of treatment (early versus late) in decreasing symptoms of anxiety and depression. Methods This retrospective cohort analysis included 3401 US-based individuals enrolled in a BC-CBT program, who presented with clinical levels of depression and/or anxiety. The treatment program consisted of regular therapy sessions augmented by clinician-assigned digital video lessons and exercises. A growth curve model incorporating time-varying covariates examined the relationship between engagement with BCT components (ie, therapy sessions, digital video lessons, and digital exercises) during the early (weeks 0-7) and late (weeks 8-15) phases of treatment, and weekly symptom reports on depression and anxiety measures. Results On average, a significant decline in depression and anxiety symptoms was observed during the initial weeks of treatment (P<.001), with a continued, though slower, decline over subsequent weeks (P<.001). Each session completed was associated with significant decreases in anxiety (b=–0.72) and depression (b=–0.83) in the early phase, as well as in the late phase (anxiety, b=–0.47; depression, b=–0.27). Significant decreases in anxiety (b=–0.15) and depression (b=–0.12) were observed for time spent on video lessons (measured in 10-minute intervals) in the early phase of treatment. Engaging with exercises was associated with statistically significant increases in anxiety symptoms (b=0.03) during the early phase of treatment. However, sensitivity analyses examining the effects of exercises in isolation revealed significant decreases in anxiety (b=–0.05) in the early phase, suggesting a potential suppression effect in the larger model. Conclusions Using a retrospective cohort design, therapy sessions and digital video lessons were uniquely predictive of improvements in depression and anxiety symptoms, and their effects were modulated based on the phase of treatment (early vs late). Future research should investigate whether other treatment variables, such as therapeutic alliance or familiarity with technology, are related to differential effects on various components of care.

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Section: Introductionmentioning

confidence: 99%

Examining the Impact of Digital Components Across Different Phases of Treatment in a Blended Care Cognitive Behavioral Therapy Intervention for Depression and Anxiety: Pragmatic Retrospective Study

Wu¹,

Wickham²,

Chen³

et al. 2021

JMIR Form Res

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“…Perhaps the biggest challenge facing EU and US MDSW regulations is reimbursement. With evidence supporting the efficacy of digital therapeutics stacking up, more payers are coming round to the idea of MDSW reimbursement and the business case for offering it [ 37 ]. With it becoming ever clearer that MDSW, in general, and digital therapeutics, in particular, can play significant roles in the treatment of many conditions around the world, both the European Union and FDA are creating regulatory frameworks for the safety and efficacy of digital therapeutics.…”

Section: Resultsmentioning

confidence: 99%

The Assessment of Medical Device Software Supporting Health Care Services for Chronic Patients in a Tertiary Hospital: Overarching Study

Baltaxe¹,

Hsieh²,

Roca³

et al. 2023

J Med Internet Res

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Background Innovative digital health tools are increasingly being evaluated and, in some instances, integrated at scale into health systems. However, the applicability of assessment methodologies in real-life scenarios to demonstrate value generation and consequently foster sustainable adoption of digitally enabled health interventions has some bottlenecks. Objective We aimed to build on the process of premarket assessment of 4 digital health interventions piloted at the Hospital Clinic de Barcelona (HCB), as well as on the analysis of current medical device software regulations and postmarket surveillance in the European Union and United States in order to generate recommendations and lessons learnt for the sustainable adoption of digitally enabled health interventions. Methods Four digital health interventions involving prototypes were piloted at the HCB (studies 1-4). Cocreation and quality improvement methodologies were used to consolidate a pragmatic evaluation method to assess the perceived usability and satisfaction of end users (both patients and health care professionals) by means of the System Usability Scale and the Net Promoter Score, including general questions about satisfaction. Analyses of both medical software device regulations and postmarket surveillance in the European Union and United States (2017-2021) were performed. Finally, an overarching analysis on lessons learnt was conducted considering 4 domains (technical, clinical, usability, and cost), as well as differentiating among 3 different eHealth strategies (telehealth, integrated care, and digital therapeutics). Results Among the participant stakeholders, the System Usability Scale score was consistently higher in patients (studies 1, 2, 3, and 4: 78, 67, 56, and 76, respectively) than in health professionals (studies 2, 3, and 4: 52, 43, and 54, respectively). In general, use of the supporting digital health tools was recommended more by patients (studies 1, 2, 3, and 4: Net Promoter Scores of −3%, 31%, −21%, and 31%, respectively) than by professionals (studies 2, 3, and 4: Net Promoter Scores of −67%, 1%, and −80%, respectively). The overarching analysis resulted in pragmatic recommendations for the digital health evaluation domains and the eHealth strategies considered. Conclusions Lessons learnt on the digitalization of health resulted in practical recommendations that could contribute to future deployment experiences.

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“…Additionally, digital therapeutics can potentially reduce reliance on pharmaceutical products and optimize drug utilization. A key feature of personalized medicine is the ability to personalize treatment strategies with individual clinical data, offering a unique opportunity to tailor treatment to the specific needs of each patient 58 …”

Section: Digital Healthmentioning

confidence: 99%

“…A key feature of personalized medicine is the ability to personalize treatment strategies with individual clinical data, offering a unique opportunity to tailor treatment to the specific needs of each patient. 58 …”

Section: Digital Healthmentioning

confidence: 99%

Digital health in chronic obstructive pulmonary disease

Long

Chen

2023

Chronic Diseases and Translational Medicine

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Chronic obstructive pulmonary disease (COPD) can be prevented and treated through effective care, reducing exacerbations and hospitalizations. Early identification of individuals at high risk of COPD exacerbation is an opportunity for preventive measures. However, many patients struggle to follow their treatment plans because of a lack of knowledge about the disease, limited access to resources, and insufficient clinical support. The growth of digital health-which encompasses advancements in health information technology, artificial intelligence, telehealth, the Internet of Things, mobile health, wearable technology, and digital therapeutics-offers opportunities for improving the early diagnosis and management of COPD. This study reviewed the field of digital health in terms of COPD. The findings showed that despite significant advances in digital health, there are still obstacles impeding its effectiveness. Finally, we highlighted some of the major challenges and possibilities for developing and integrating digital health in COPD management. K E Y W O R D SCOPD management, chronic obstructive pulmonary disease, digital health Highlights• Digital health can support the early diagnosis and management of Chronic obstructive pulmonary disease, but there are still important challenges and opportunities to be addressed.

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Application of blended care as a mechanism of action in the construction of digital therapeutics

Cited by 9 publications

References 3 publications

Examining the Impact of Digital Components Across Different Phases of Treatment in a Blended Care Cognitive Behavioral Therapy Intervention for Depression and Anxiety: Pragmatic Retrospective Study

Examining the Impact of Digital Components Across Different Phases of Treatment in a Blended Care Cognitive Behavioral Therapy Intervention for Depression and Anxiety: Pragmatic Retrospective Study

The Assessment of Medical Device Software Supporting Health Care Services for Chronic Patients in a Tertiary Hospital: Overarching Study

Digital health in chronic obstructive pulmonary disease

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