JMIR Publications

ABSTRACT

Background:

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 they recommend them to in the clinical setting.

Objective:

Characterize the clinical and demographic characteristics of patients receiving DTx recommendations, and describe provider characteristics and behaviors regarding DTx.

Methods:

Retrospective cohort study using electronic health record (EHR) data from a large, integrated, healthcare delivery system. Demographic and clinical characteristics of adult patients recommended versus not recommended DTx by a mental health provider between May 2020-December 2021 were examined. A cross-sectional survey of mental health providers providing these recommendations was conducted assessing characteristics of providers and recommendation behaviors related to DTx. Parametric and nonparametric tests were used to examine statistical significance between groups.

Results:

Of 335,250 patients with a mental health appointment, 53,546 (16%) received a DTx recommendation. Patients recommended to DTx were younger, of Asian or Hispanic race or ethnicity, female, without medical comorbidities, and had commercial insurance, compared to those without a DTx recommendation (P<.0001). More patients receiving a DTx recommendation had anxiety or adjustment disorder diagnoses but less had depression, bipolar, or psychotic disorder diagnoses (P<.0001), 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 non-prescribers recommended DTx to patients compared to prescribers (P<.01). Of all providers, 29.4% reported using the suggested internal EHR-based tools (e.g. smart text) to recommend DTx, and of providers recommending DTx resources to patients, 64.1% reported they follow-up with patients to inquire on DTx benefits. Only 38.4% of respondents report recommending specific DTx modules, and of those 58.6% report following up on the impact of these specific modules.

Conclusions:

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.