behavioral health

Innovation Series, Part 2: App for Substance Abuse Disorders

Scientific Breakthroughs: From Gene Therapy to Creative New Approaches to Cancer Surgery, Patients Stand to Benefit Dramatically, But How Will We Pay For This Innovation?

Innovation Series, Part 2: App for Substance Abuse Disorders

From gene therapy to a “pen” that can detect cancerous tissue in 10 seconds, we live in a time of amazing scientific breakthroughs. Advances in technology and our understanding of the genetic basis of disease are resulting in a range of innovations that hold the promise of improving our approaches to treatment – including things like new treatment options for rare diseases and innovations that are more consumer friendly.

Last year, for example, the U.S. Food and Drug Administration (FDA) approved for marketing the first mobile application to help treat substance use disorders. Yes, there’s an app for that! Cognitive behavioral therapy (CBT) is a kind of talk therapy that is a proven treatment for a number of mental health and substance abuse disorders. The newly approved app, developed by Pear Therapeutics, essentially makes CBT digital. The app, called reSET®, is designed to be used in conjunction with counseling and would be prescribed as appropriate by a health care provider.

Digital therapeutics are a hot space for health care start-ups and Pear Technologies is leading the way. Founder and CEO of the company, Corey McCann told CNBC, “This is the moment for digital therapeutics.” While not yet available for sale in the U.S., the clinical data that led to FDA approval is promising. The trial included more than 500 patients with substance use disorder (SUD) over a 12-week period. The randomized trial compared intensive face-to-face counseling – a standard treatment for SUD – to reSET® combined with a reduced amount of face-to-face counseling. Of the patients using reSET® who were dependent on stimulants, marijuana, cocaine, or alcohol, nearly 60% were abstinent at the end of the study period, while just 30% of patients who received only the face-to-face counseling were abstinent.

Of note, data from the clinical studies indicated no side effects from the device. If a prescription digital therapy improves patient outcomes and has few or no side effects, should it be reimbursed at a higher rate than a competing intervention that is safe but has more side effects for the patient? Meeting the patient where she or he is seems obvious, and prescription digital therapeutics are another great example of innovation that is consumer-focused.

What do all of these new and potentially lifesaving innovations mean for the health care system? As with any innovation that offers new hope for patients, there will likely be high demand, but that will have to be considered in the context of limited resources. We are witnessing significant new innovations and scientific advancement; the usual questions of access and how to pay for it will be dramatically amplified in this modern era, given the unprecedented price tags.

Evidence is not enough to change health behaviors

By M2|2017-10-09T02:01:03+00:00March 22nd, 2017|Uncategorized|

Evidence is not enough to change health behaviors

Tobacco use continues to be a major cause of avoidable death, and costs the U.S. health care system billions of dollars per year. However, elderly heart attack survivors rarely filled their prescriptions for smoking cessation drugs upon discharge from the hospital, despite counseling from hospital staff on the need to quit, according to a study presented at the American Heart Association’s most recent annual meeting.

The study evaluated nearly 2,400 heart attack survivors over the age of 65 who were current or recent smokers. Almost all of the patients in the study received prescriptions for smoking cessation medicines before discharge.

However, only about 10 percent of patients actually filled a prescription for the smoking-cessation drugs bupropion (GlaxoSmithKline’s Wellbutrin) or varenicline (Pfizer’s Chantix) within 90 days of discharge from the hospital.

The rate also did not change much over time: At one year post-discharge, only 13 percent filled a prescription for these drugs.

“There remains a great deal of room for improvement in intensifying smoking cessation interventions during and after a patient’s hospital stay for a heart attack,” the researchers, led by Duke University’s Neha Pagidipati, MD, said in a press release.

“These findings come as no surprise for geriatricians and health care professionals who face on a daily basis the challenges of recognizing and managing the complexity of caring for older adults,” Dr. Gisele Wolf-Klein, director of geriatric education, Northwell Health (Great Neck, NY) said in an article in HealthDay News.

Elderly patients face many challenges, such as “multiple medical conditions, which often include depression and forgetfulness,” which can make it more challenging for them to initiate and adhere to a smoking cessation regimen, she said.

Although she agreed with the researchers that more needs to be done during their hospital stay to help patients quit smoking, she said there are reasons patients fail to use smoking-cessation products.

For example, “older adults are particularly concerned with taking too many medications, both because of the increasing and often unsurmountable monthly costs of their prescribed drug regimen, and because of the difficulty of remembering when to take them,” she said.

Too often, patients are simply handed the medications without much explanation; “before buying into” smoking-cessation treatment, “older adults will need strong scientific data to persuade them – and their caregivers – of the longevity and quality of life benefits of giving up one of their last pleasurable habits,” she said.

Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital, New York City, agreed that “we clearly have a long way to go in continued long-term counseling” for elderly heart patients who smoke. “We need to enhance our smoking-cessation counseling outside of the hospital by providing additional assistance and education to our patients,” Bhusri said. “The importance of not smoking after a heart attack is crucial to recovery and prevention of future heart attacks.”

This study highlights the challenges inherent in changing behaviors that impact health. The evidence is clear – elderly heart attack patients should stop smoking; however, this will require behavior change on the part of both the physician (in terms of coaching patients) and patients (in terms of adhering to prescribed regimens).