Prescription Digital Therapeutics in Behavior-Driven Conditions - Episode 4

Prescription Digital Therapeutics: Clinical Outcomes

January 6, 2021

Current experiences noted by various stakeholders in healthcare regarding the impact of prescription digital therapeutics in clinical practice as tools to help manage patients with behavior-driven conditions, and current limitations that need to be addressed to increase their uptake.

Megan Coder, PharmD, MBA:Dr Moukaddam, how do these products impact the ability for patient satisfaction and improvements in clinical outcomes and health care costs?

Nidal Moukaddam, MD, PhD: We have an idea and we have some wishful thinking about this, but I don’t think we have all the scientific evidence that we want. We know that literature tells us people are happy typically when they have some sort of digital or technology follow-up, whether it be for wound care or for diabetes. We know that patients find it effective and easy once they find out how to use it.

The therapeutic decreases loneliness tremendously. The patient satisfaction element is there. The clinician satisfaction element is not necessarily present because it is something that needs time and you need to follow up on these outcomes. You need to teach people, and then reinforce that they’ve understood, and you need to ask them if they’ve used it and if they haven’t, you then must track that behavior down. As a result, I don’t think the clinician satisfaction is as high.

As the other panelists have suggested, it is a cheap intervention. It is relatively inexpensive if you have a smartphone. The trick with this whole PDT [prescription digital therapeutics] area is to make sure that we’re not just using it for people who already have a smartphone and have the support. Otherwise, you’re really highlighting socioeconomic disparities.

Megan Coder, PharmD, MBA: Looking at it from that perspective and building on from the clinician’s side, how have you seen digital therapeutics be integrated into clinical workflows or into electronic health records? I know that there are different companies that will enable this to happen, but I’m curious if you’ve had any hands-on experience with it?

Nidal Moukaddam, MD, PhD: I have a couple of instances of hands-on experience. The answer to your question is that this is a nascent field, it’s just starting, and it is still up for grabs. There are a lot of liability issues because if you add another source of information, you are adding liability. It will potentially be a problem if you miss a finding that could’ve alerted you to a bad patient outcome. I don’t think the liability aspect has been properly explored, and there are no proper guidelines for this quite yet.

Regarding time, everything you do will add time, and I don’t think people have time in their schedules for this, which must be built in. There is the integration aspect whereby people need to learn how to integrate this into their workflow. I have given a couple of lectures on this, and whenever I say to people, “You have to pull up a phone and show the person how to use an app,” I get these looks like, “What are you talking about? Where am I going to find the time?”

Overall, finding time is a problem. However, there are companies that will take the liability issue off your hands and will store that data and make it their business to integrate with your electronic health record. You can also customize your electronic health record if you are in an institution where you have this kind of say-so. Either you take on that info and you take on that responsibility, or you outsource it, which are the main 2 options in a brand-new field.