Are Digi therapeutics a viable proposition in dementia care?

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Digi therapeutics and Digi pharma are new terms recently arrived in the UK from the US that define the emerging yet for many as yet unevaluated trends in the UK. Namely the ability of apps to act effectively either alongside or independently of medication. New care tech is causing treatment paradigms to be reconsidered. For previously, it was almost impossible to match treatment with cognitive and behavioral changes but now Digital Therapeutics and Digiceuticals enable more flexible treatment and monitoring alternatives. And can provide much needed cost savings.

Digital Therapeutics is defined as immersive applications that act reliably and remotely to change individual’s behaviors to achieve positive clinical outcomes and reduce medical cost growth. They’re often used in conjunction with medication but may replace conventional prescribing.

Digi Pharma is consumer focused, such as nutritional supplements. They’re typically not reimbursed, FDA/NHS authorized and low priced, with consumers paying directly after marketing discovery.

Whilst software is of course being used increasingly, it is only recently that the NHS has begun to categorise and evaluate the benefits of apps in care, not least because from a business standpoint, it has been shown in the US that the development costs of apps are far less than pharma and that the return on investment is proving to be greater and occurring sooner. The NHS is naturally paying attention to such statements and it is believed that the cost benefits are transferable to residential care, since the cost of adoption is low.

Starting with early ‘wellness’ tools today’s mobile health apps remotely treat chronic conditions by helping modify patient behaviour, provide means of cognitive assessment and offer the ability to monitor adherence to medication and therapy. But their use is progressing to the app providing an alternative to the medication itself. With the rapid advance of both the efficiency of voice recognition and the AI inherent in for example Alexa, even the impact of voice driven apps on a person’s wellbeing is being evaluated, such as for example by Cambridge Cognition and Health-Connected’s RemindMeCare.

So where does RemindMecare (ReMe) fit in? ReMe discovers personal content through interactive response to digital activities that positively impact on behavior and calm agitation, reducing or complimenting the use of medication. ReMe achieves improved wellbeing, shows a propensity to support cognitive retention and recall and can be used in therapy and acute care strategies. So, in terms of definition, since ReMe is used both at home and in residential and ward care and can be self-downloaded or GP prescribed, ReMe falls into both the pharma and therapeutic categories, subject to the deployment used.

The digital delivery of reminiscence, music, cognitive stimulation and conversational therapies and the ability to measure and quantify outcomes enable developing acute dementia strategies that are personalised to an individual and focused at specific targets, such as pain reduction and social engagement through discovered commonality of interests and the management and monitoring of wellbeing. Digital tools also have a large role to play in the training of staff in enhanced dementia care strategies.

Current studies in Kingston Hospital, London, aim to establish ReMe’s potential to improve the admission processes and reduce the premature resort to medication to achieve calm through knowing the person, to enhance person centered care, deliver bespoke 1:1 and group activities, as well as achieve efficiency and cost savings through digital reporting, reduced staffing, earlier discharge and optimized step down. The study, managed by Kingston University, is available upon request. For info. see https://www.kingstonhospital.nhs.uk/news-events/news/remindmecare-at-kingston-hospital.aspx .

These positive impacts can be directly applied in all care settings and require only the easily achieved informed administration of a carer and the participation ideally of family to optimize the availability of personal knowledge of the person.

But efficacy becomes irrelevant with many apps if the data is not compliant. Therefore, other elements that impact on the potential of digital interventions include privacy issues and the portability of the data from one care organization to another. ReMe has an inbuilt data security and consent-based enrolment and usage process, that provides robust data security and a means to ensure GDPR compliancy for the care organization.

In conclusion, the benefits of digital interventions are immediately available and ReMe is being used globally for care at home, by care homes, day care centres and wards, however ReMe also offers an early insight into what may be coming next in the world of MedTech.

Please see RemindMeCare