Emergence of digital therapeutics boosts access to GI behavioral resources
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As the field of gastroenterology evolves, gone are the days when a gastroenterologist is expected to meet the needs of every patient.
Research has shown the benefits of tailoring a patient’s treatment team to include a GI psychologist, registered GI dietitian, pelvic floor therapist and more. A multidisciplinary, integrative team adds value to the patient experience and improves outcomes (Basnayake et al). While the field and patients are eager to incorporate behavioral therapy into their treatment plan, access to this type of integrative care is still quite difficult in many parts of the world.
For example, there are 40 million Americans diagnosed with irritable bowel syndrome and just over 400 mental health experts in the field of psychogastroenterology worldwide. Demand far exceeds the ability to access effective brain-gut behavioral therapies (Keefer et al). As a result, the emergence of digital therapeutics holds promising opportunity to create scalable solutions that improve access to GI behavioral resources and treatment for patients in need.
Understanding this new landscape of GI behavioral health care is important, as the options and tools are not one size fits all (Riehl). Just as it is important to understand the appropriate patients to refer to a GI psychologist, we now have an exciting area of research in terms of identifying patient characteristics that are best suited for digital therapeutics. While I believe these solutions will be of great value to many, there will be some who must be prioritized to suitable in-person mental health treatment.
Innovations in psychogastroenterology delivery
- GI mental health provider is best for an insightful and motivated patient interested in evidence-based psychological interventions for the management of their GI condition. Where to turn for care: www.romegipsych.org
- General mental health provider is best for a patient who has moderate to severe anxiety, mood or psychiatric symptoms that are partially related or unrelated to their GI condition; this can sometimes overlap working with a GI mental health provider. Where to turn for care: www.psychologytoday.com and www.nami.org
- Comprehensive psychiatric treatment is best for a patient requiring comprehensive mental health and medication management for mood stabilization, unresolved trauma and/or those with notable cognitive deficits. This type of care takes precedence to beginning GI behavioral health treatment. Where to turn for care: www.psychiatry.org/patients-families
- GI psychology educational webinars are best for patients who will benefit from learning more about their GI condition, are waiting to access care with a GI mental health expert, are using a digital therapeutic or are not yet appropriate for GI behavioral therapy. Where to turn for care: www.GIOnDEMAND.com
- Digital therapeutics (an ever-evolving, non-exhaustive list) is best for patients who are appropriate for in-person work with a GI mental health provider (ie, do not require comprehensive psychiatric care) and are interested in using self-guided, evidence-based programs that can deliver brain-gut behavioral therapy, symptom tracking and/or telemedicine via a mobile or web application. Programs delivering behavioral treatment include Nerva, Zemedy, Mahana IBS and Regulora, and symptom trackers include Dieta, mySymptoms and Cara Care. Telemedicine providers include Oshi Health and Trellus Health.
Given the evolving landscape of the GI digital therapeutic space, providers are encouraged to be aware of some of the products on the market and mindful of how to incorporate them into practice.
What might providers do as the GI digital therapeutic market advances?
Recognize that patients are hearing about these products through social media, television and medical providers. They will be curious about whether they should try them and may ask for your opinion. Consider trying them yourself to learn about the patient experience and help guide your treatment recommendations.
Know that the go-to market strategies of these products differ. For example, anyone can download the Nerva app (self-guided, gut-directed hypnotherapy program for IBS), while Mahana IBS is an FDA cleared program that delivers cognitive behavioral therapy interventions for IBS and requires a physician to prescribe the app. Each of the available products is a bit different and will require some awareness of the nuances when it comes to discussions with patients.
The future is collaborative, creative and likely to include digital
As we create innovative solutions to improve access to GI behavioral health resources and interventions, we must be open to discussing how they fit into patients’ treatment plans and follow up on their user experience. Exciting research in the delivery of treatment for a variety of GI conditions is needed and will certainly improve the lives of people interested in these invaluable services.
References:
- Basnayake C, et al. Lancet Gastroenterol Hepatol. 2020;doi:10.1016/S2468-1253(20)30215-6.
- Keefer L, et al. Gastroenterology. 2022;doi:10.1053/j.gastro.2021.09.015.
- Riehl M. Clin Transl Gastroenterol. 2022;doi:10.14309/ctg.0000000000000444.
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