Utilizing PDTs for Optimal Individualized Treatment
Through the inclusion of prescription digital therapeutics in individualized treatment plans, payers and providers are able to provide optimal and cost-effective care.
Megan Coder, Pharm.D., M.B.A.: Arwen, we’re looking at this idea around making sure it’s a patient-centered perspective: the right product for the right patient at the right time. I’m curious how you’ll make sure you have the right patient at the right time for this product knowing that you, as a psychiatrist, are going to be supporting them throughout the process. But you need to make sure that’s meant for them too. As Paul initially addressed, a patient has to engage and they have to use it to benefit from it. The idea of matching 1-to-1 is going to be important. How do you approach that perspective?
Arwen Podesta, M.D.: A talented clinician is able to understand where the patient is at, [regardless of whether they’re] in oncology, endocrinology, psychiatry or primary care. They’re able to understand where the disease state is, where the patient is and what the underlying root cause is and then remove all those things to help the patient win over the disease. We have to take a bit of time to understand where the patient is in the behavioral health space. That’s 100% necessary. In addiction treatment, we need to know if they’re in precontemplation, contemplation, action phase, etc. There are factors that go into selecting what medicine for what patient, what behavioral treatment for what patient and what clinical setting for what patient does someone need to be in—residential treatment or hospital treatment? That’s the same for all levels of all types of diseases. We need to risk stratify for the disease and what the patient needs.
If I’m selecting a prescription digital therapeutic, then they need to have access to that. That means they need to have access to the payment form through their insurance or self-pay. They need to know that they need to have a device. If they don’t have a device, Medicaid is able to cover smartphones for some patients but not in every state. If they recently got out of a long-term setting—let’s say prison—they don’t know how to use a device. They have [a smartphone] but don’t know how to use it. They haven’t used technology in 20 years. Those are considerations. They need to be able to upload, so [they need] Wi-Fi. If they don’t have it at home, they need to have a connection. Those are some considerations.
For Somryst, which is the sleep app I use and the prescription digital therapeutic for insomnia, those are all considerations as well. If someone doesn’t truly have insomnia—they complain of some sleep, but they have four dogs snore and sleep on the bed—this prescription digital therapeutic isn’t going to help. We need to know the underlying problems. For those who are using reSET and reSET-O for substance use disorders, if you’re in a residential treatment setting and don’t have use of your device, don’t prescribe it. If you’re at the beginning of an intensive outpatient program, and you’ve just started using it as of today, wait a little longer. In my intensive outpatient programs, I encourage prescribers to write for it toward the end. That way, they do their intensive outpatient with individuals and groups for 12 hours a week for eight to 12 weeks. Then toward the end, weeks six through 12, they might be using the prescription digital therapeutic, which will augment and be an arm of treatment and an extender of treatment. Those are my considerations.
Megan Coder, Pharm.D., M.B.A.: Thank you for that response. That was thorough in how you walked through that thought process. My other follow-up question is to you as a clinician. How do you feel you’re prepared to dive into this discussion? I imagine there are a lot of other physicians and health care providers who are trying to figure out how to step into this. How do you first learn about this? How do you have the right tools to do this with confidence?
Arwen Podesta, M.D.: A lot of clinicians, a lot of prescribers, are scared of jumping in because they don’t know enough about it. They don’t see the studies. The studies are valid, which is why Dr Cannon and Dr Jeffrey are able to talk about them being FDA-authorized therapeutics. The FDA gives them great scrutiny. If we trust the FDA to do that, just as we do with medications, then when we have something that may benefit our patients. I’m an early adopter of a lot of things, especially in the addiction space, because we have so much need and a lot of risk of dying. It’s very scary for those of us treating this disease.
I encourage individuals to briefly read some of the studies, to talk to other people like myself who are using these, to get educated about what their patients might benefit from and to give it a try. Giving it a try usually provides good feedback. I get neurofeedback from looking at my dashboard and seeing which patients are doing much better, and now I see that they’ve been using this every day for this period of time. I get the good contingency management feedback, like, “I’m doing the right thing.” Patients give me that feedback, and then they have great successes. I encourage individuals to get started on it, understanding how to prescribe it, how to onboard these tools and how to use them.
Using the dashboard is essential. It’s not as if you’re sending someone to download this app, and then they’re out in the wind. Just like with medication, we don’t know if they’re taking it, we don’t know if they’re using it properly and we don’t know how frequently they’re using it. The onus is on the clinician, the prescriber, to view the dashboard if not weekly then at least a couple of times between appointments. That way, you can see what the success or deficit is. The goal of this is to help with treatment but also to alter the treatment plan or have the prescriber alter the treatment plan if the patient isn’t succeeding.
Megan Coder, Pharm.D., M.B.A.: Because these products have been validated clinically, I appreciate that the data that are coming back to you, as clinicians, are actionable. You can move on that. It’s not necessarily a patient’s diary of their perspectives. It’s real data in addition to their own reported outcomes. Thank you for talking about that.
Transcript edited for clarity.
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