Ridout Samuel J, Ridout Kathryn K, Lin Teresa Y, Campbell Cynthia I
Department of Psychiatry, San Jose Medical Center, The Permanente Medical Group, San Jose, CA, United States.
Kaiser Permanente Northern California Division of Research, 4480 Hacienda Drive, Pleasanton, CA, 94588, United States, 1 650 380 2507.
JMIR Ment Health. 2024 Oct 2;11:e56574. doi: 10.2196/56574.
While the number of digital therapeutics (DTx) has proliferated, there is little real-world research on the characteristics of providers recommending DTx, their recommendation behaviors, or the characteristics of patients receiving recommendations in the clinical setting.
The aim of this study was to characterize the clinical and demographic characteristics of patients receiving DTx recommendations and describe provider characteristics and behaviors regarding DTx.
This retrospective cohort study used electronic health record data from a large, integrated health care delivery system. Demographic and clinical characteristics of adult patients recommended versus not recommended DTx by a mental health provider between May 2020 and December 2021 were examined. A cross-sectional survey of mental health providers providing these recommendations was conducted in December 2022 to assess the characteristics of providers and recommendation behaviors related to DTx. Parametric and nonparametric tests were used to examine statistical significance between groups.
Of 335,250 patients with a mental health appointment, 53,546 (16%) received a DTx recommendation. Patients recommended to DTx were younger, were of Asian or Hispanic race or ethnicity, were female, were without medical comorbidities, and had commercial insurance compared to those without a DTx recommendation (P<.001). More patients receiving a DTx recommendation had anxiety or adjustment disorder diagnoses, but less had depression, bipolar, or psychotic disorder diagnoses (P<.001) versus matched controls not recommended to DTx. Overall, depression and anxiety symptom scores were lower in patients recommended to DTx compared to matched controls not receiving a recommendation, although female patients had a higher proportion of severe depression and anxiety scores compared to male patients. Provider survey results indicated a higher proportion of nonprescribers recommended DTx to patients compared to prescribers (P=.008). Of all providers, 29.4% (45/153) reported using the suggested internal electronic health record-based tools (eg, smart text) to recommend DTx, and of providers recommending DTx resources to patients, 64.1% (98/153) reported they follow up with patients to inquire on DTx benefits. Only 38.4% (58/151) of respondents report recommending specific DTx modules, and of those, 58.6% (34/58) report following up on the impact of these specific modules.
DTx use in mental health was modest and varied by patient and provider characteristics. Providers do not appear to actively engage with these tools and integrate them into treatment plans. Providers, while expressing interest in potential benefits from DTx, may view DTx as a passive strategy to augment traditional treatment for select patients.
虽然数字疗法（DTx）的数量激增，但关于推荐DTx的提供者的特征、他们的推荐行为或在临床环境中接受推荐的患者的特征，几乎没有现实世界的研究。
本研究的目的是描述接受DTx推荐的患者的临床和人口统计学特征，并描述提供者关于DTx的特征和行为。
这项回顾性队列研究使用了来自一个大型综合医疗保健系统的电子健康记录数据。研究了2020年5月至2021年12月期间心理健康提供者推荐与未推荐DTx的成年患者的人口统计学和临床特征。2022年12月对提供这些推荐的心理健康提供者进行了横断面调查，以评估提供者的特征以及与DTx相关的推荐行为。使用参数检验和非参数检验来检验组间的统计学显著性。
在335,250名有心理健康预约的患者中，53,546名（16%）接受了DTx推荐。与未接受DTx推荐的患者相比，被推荐使用DTx的患者更年轻，为亚洲或西班牙裔种族或族裔，为女性，没有合并症，并且拥有商业保险（P<0.0（此处原文有误，推测是P<0.001））。与未被推荐使用DTx的匹配对照组相比，更多接受DTx推荐的患者被诊断为焦虑或适应障碍，但被诊断为抑郁症、双相情感障碍或精神障碍的患者较少（P<0.001）。总体而言，与未接受推荐的匹配对照组相比，被推荐使用DTx的患者的抑郁和焦虑症状评分较低，尽管女性患者中重度抑郁和焦虑评分的比例高于男性患者。提供者调查结果表明，与开处方者相比，非开处方者向患者推荐DTx的比例更高（P = 0.008）。在所有提供者中，29.4%（45/153）报告使用建议的基于电子健康记录的内部工具（如智能文本）来推荐DTx，在向患者推荐DTx资源的提供者中，64.1%（98/153）报告他们会跟进患者以询问DTx的益处。只有38.4%（58/151）的受访者报告推荐了特定的DTx模块，其中58.6%（34/58）报告跟进了这些特定模块的影响。
DTx在心理健康领域的使用较少，且因患者和提供者特征而异。提供者似乎没有积极使用这些工具并将其纳入治疗计划。提供者虽然对DTx的潜在益处表示感兴趣，但可能将DTx视为增强特定患者传统治疗的被动策略。
