Technology’s causing treatment paradigms to be reconsidered. Previously, it was almost impossible to match treatment with cognitive and behavioral changes. Today ‘Digi’ apps offer more flexible treatment and monitoring alternatives. Digital therapeutics are defined as immersive programs that act reliably and remotely to change individual’s behaviours to achieve positive clinical outcomes and reduce medical cost growth. They’re used in conjunction or instead of conventional prescribing. Digi Pharma is consumer focused, typically low priced and not FDA/NHS approved.
Forbes states that the “future of healthcare will be app based.” Grand View Research projected ‘the global digital therapeutics market to grow to $9 billion by 2025, driven by the benefits it affords patients, including continuous monitoring of vital signs, medication management, healthcare reminders and a person centred focus’
One unique aspect of DT’s is its ability to promote health improvements through behavioral changes alone. Virta Health Corp. raised $37 million for an app that coaches diabetics on a diet to reverse their condition without drugs or surgery, whilst Big Health developed Sleepio, an insomnia app now used in the UK. But if mobile apps are to be used to monitor patients’ adherence to therapy, even compliment or replace drugs, then there’s clearly a need for clinical laboratory tests and regulators to work supportively. Otherwise, how will care stakeholders know if patients’ biomarkers have improved or regressed? The US is taking the lead whilst in the UK, NHS Digital and EMIS are building libraries of apps that have been validated by consultancies such as Orcha, Our Mobile Health and NQVIA and hospitals are undertaking clinical evaluations.
One UK app currently in the library pipeline is RemindMeCare. Used in formal care (ie Signature, Bluebird and in trials with Genesis and Extracare), ReMe is undertaking in-ward evidence based studies to establish the benefits of digitally delivered person-centred activities for patients with dementia. ReMe aims to reduce agitation through its person defining ELR’s (electronic life records, such as life story, preferences, habits) achieving calm, thereby reducing/replacing medication. ReMe enables personalised activities to be delivered, in 1:1 and group settings, that have been previously used by family or care home, and that generate familiarity and reassurance. The metrics under evaluation are; readmissions/failed discharges, care homes discharge rate, supervision and falls rates, use of antipsychotics and anti-depressants, wellbeing and mood, night restlessness and agitation, staff outcomes including workload and staff retention. The enhanced person-centred care pathway aims to reduces costs with improved step-down and discharge back to the point of origin. With plans sanctioned to expand ReMe into stroke and acute wards, it’s also intended to explore how ReMe can support self-care management post stepdown. ReMe offers an insight into what the future for post dementia support may look like.
The cost saving impact of digital prescribing could be substantial but undoubtedly care industry and GP acceptance will come slowly, until the evidence speaks for itself. But as our population ages and GP shortages increase, digital therapeutics may help address patient needs in a quality and cost-effective manner.
The ReMe app is now available for download here