The exponential growth of digital health therapeutics within the last fifteen years, is providing ever increasing novel and efficient ways of delivering support to those accessing healthcare. However, despite there being many products that exist in the digital health space, healthcare providers, commissioners and staff often struggle to identify the most appropriate one. This webinar will seek to answer what type of evidence clinicians should look for when choosing a safe and effective product for their patients.
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Dr Paul Wallace, Clinical Director Digital, Health Innovation Network; Academic Lead, DigitalHealth.London Generator; Professor Emeritus Primary Care, University College London
Dr Farah Elahi, Project Manager, DigitalHealth.London
Dr Annie Murphy, GP Partner and Southwest London Digital Lead for Primary Care, Digital Pioneer Fellow (Cohort 2)
Dr Alice Sibelli (PhD), Associate Director of Clinical Therapy Design – Mahana Therapeutics
We’ve summarised the key themes from the discussion:
In late May 2022, NICE issued approval for app-based therapy, Sleepio, for sleep disorders. This was only possible because of the extensive, robust evidence base associated with the app.
Jeanette Kusel, acting director for MedTech and digital at NICE, said: “Our guidance on Sleepio provides GPs and their patients with evidence-based recommendations on a digital treatment option for insomnia. Our rigorous, transparent and evidence-based analysis has found that Sleepio is cost saving for the NHS in primary care compared with sleeping pills and sleep hygeine. It will also reduce people with insomnia’s reliance on dependence forming drugs such as zolpidem and zopiclone.
This is a very important development which helps pave the way for other technologies in this field and set the scene very nicely for the discussion…
What does the term “digital therapy” mean?
Evidence-based therapies that are delivered by software programmes. They can help treat or manage a disease or disorder. They are not wellness apps – they need to be cleared by regulatory bodies or they need to be certified. Digital Therapeutics Alliance has useful resources to learn more about digital therapies.
Annie shared that from a clinician/user point of view, there is a mind-boggling number of healthtech apps and products out there and it is currently hard to choose the right one. She felt that Covid-19 had been a huge disrupter in this field. Areas she’s seen digital therapeutics include mental health where there are self-help and CBT apps, as well as many digitally assisted programmes. The other main area is remote monitoring for long term conditions, diabetes for example has received a recommendation by NICE to use continuous glucose monitoring. Annie emphasised the importance of having the backing of evidence, NICE backing and/or DTAC approval to trust these therapies.
How important a role will digital therapeutics play?
Alice shared that currently 1.6 million are on the waiting list for mental health care and 8 million people have psychiatric disorders but are unable to access waiting list. Digital therapies can help with the management of long-term mental health conditions. Mahana’s CBT is safe and effective and helps with the symptoms and psychological stress associated with IBD.
Annie noted that patients now often prefer online solutions to face-to-face, illustrating a huge opportunity for digital therapeutics. Her only concern with the future of digital therapeutics, especially around remote monitoring, was the risk of information overload for the person and for the clinicians. Excess data can sometimes cause even more health anxiety.
Alice highlighted accessibility as one of the key challenges in the future, especially in deprived areas which are particularly affected by long-term conditions.
Challenges for clinicians
Annie shared that the volume of technologies out there creates confusion and means it is difficult to suggest standardised therapies when there is no standard. They can only base advice on the technologies they’ve already used, and they don’t have time to research others or run endless pilots. Annie suggested the best solution would be a centralised body who could make recommendations. ORCHA is a helpful resource but what would be even more useful from a procurement perspective, would be national guidance and frameworks to ensure a fair and consistent process.
Hardwiring evidence generation into digital
Alice identified the importance of collecting real-world evidence, not just clinical evidence through RCTs. This is all costly for companies but it is vital to understand how to embed a technology.
Annie highlighted issues in the capacity of the workforce, the lack of technological expertise to understand the data and to evaluate at a local level. It is vital to have dialogue between companies, commissioner and users, and to have a mixed approach of top down, standardised measures as well as innovation from the ground.