NICE approves digital health therapies for psychosis treatment in the NHS
The National Institute for Health and Care Excellence (NICE) has officially approved three innovative digital therapies for incorporation into the treatment of psychosis within the NHS, pending further investigation into their benefits. This provisional approval, part of an early value assessment, encompasses AVATAR Therapy, SlowMo, and CareLoop, each targeting different aspects of psychosis management.
AVATAR Therapy utilises sophisticated software to create a digital representation or avatar of the distressing voices often heard by individuals suffering from psychosis. This digital approach involves patients in therapeutic dialogues spanning six to twelve sessions, wherein a mental health professional animates the avatar. This interaction is designed to facilitate a tripartite conversation, aiming to reduce the impact of auditory hallucinations.
SlowMo, on the other hand, emerges from a collaboration between the Psychosis Research Partnership at King’s College London and the Helen Hamlyn Centre for Design at the Royal College of Art. This therapy employs a web application linked to a smart device to help individuals recognise and moderate the rapid thought processes associated with psychosis, particularly paranoia. By slowing down these thoughts, the therapy aims to lessen the distress they cause.
The third therapy, CareLoop, is an application focused on preventing relapses. It enables patients to document their symptoms, thoughts, and feelings through a journaling feature and structured questionnaires. An underlying algorithm analyses these entries to detect early signs of potential relapse, allowing healthcare teams to intervene promptly.
These three digital health technologies are now available for use within NHS care teams on the condition that they actively collect and share data on their effectiveness over a three-year period, providing annual reports to NICE.
Furthermore, a separate assessment by NICE has recognised the potential of gameChangeVR, a virtual reality technology, for treating severe agoraphobic avoidance in individuals with psychosis, marking another step forward in digital health solutions for mental health.
NICE’s reports underline several advantages these digital therapies may offer, including improved accessibility to mental health services—which are currently under high demand and unevenly distributed across the NHS. These technologies not only provide an alternative treatment option for those unable to access traditional psychological interventions but also require no specialised training in cognitive behavioural therapy for psychosis (CBTp), potentially broadening the pool of mental health professionals who can deliver these services. Additionally, when integrated with standard care, these digital solutions could decrease the frequency of therapy sessions needed.
Earlier in the year, NICE also supported the use of Brainomix’s stroke management software, further demonstrating its commitment to integrating digital health technologies into healthcare provision.
Read MoreNew machine learning approach transforms behavioural health medication practices
At the recent AMCP Nexus 2023 conference in Orlando, Florida (16th-19th of October), presenters showcased a groundbreaking machine learning program designed to address medication-related issues in individuals with behavioural health conditions. This program has shown promising results in reducing polypharmacy, enhancing medication adherence, and decreasing healthcare costs.
Behavioural health conditions pose a significant challenge to healthcare systems. A 2020 Milliman study examining commercial healthcare claims data from 2017, which encompassed 21 million people, revealed that although only 27% had a behavioural health condition, they accounted for over half of the total healthcare expenditures. In this context, machine learning offers a potential solution for better managing these conditions.
The presenters highlighted the issue of polypharmacy, a common concern in behavioural health where 60% of adults with a condition are prescribed two or more psychotropic medications. Polypharmacy not only increases the risk of drug interactions and adverse events but also contributes to soaring healthcare costs. Dr. Caroline Carney, Chief Medical Officer at Magellan Health, underscored the tendency for medication overlap and overprescription in treating conditions like depression and anxiety, often leading to unnecessary medication layers.
Another issue in managing behavioural health medications is the multiple prescribers involved, including primary care doctors, specialists, and inpatient clinicians, often resulting in uncoordinated treatment. This lack of coordination can leave patients confused and overwhelmed with their medication regimens.
To combat these challenges, Magellan Health collaborated with Arine, a medication management tech startup, to create inforMED (formerly known as Navigate Whole Health). This AI-driven program identifies prescribers who can potentially optimise patient care, generating comprehensive care plans with treatment recommendations and patient education. The program’s effectiveness is continuously improved by incorporating new clinical outcome data.
Dr. Carney elaborated on the program’s approach, which considers hundreds of parameters, providing prescribers not just with medication change suggestions but also with reasons, implications, and evidence-based support for the recommended changes.
Yoona Kim, PharmD, PhD, co-founder and CEO of Arine, explained that machine learning algorithms are utilised to target prescribers based on their prescribing patterns and the presence of prescribing outliers in their patient panels. The program also considers social determinants of health, using ZIP code data to assess potential barriers to healthcare access, such as low income or lack of vehicle access.
The results of this program have been significant. Dr. Kim reported a reduction in behavioural health polypharmacy by 45% to 55%, a 20% increase in medication adherence, a 20% reduction in average daily morphine milligram equivalents, and a savings of $360 to $840 in pharmaceutical costs per enrolled member annually.
Dr. Carney emphasised the program’s success in providing actionable data and guidance to healthcare providers, leading to improved patient outcomes and stronger, longer-lasting professional relationships. This innovative approach signifies a major step forward in the management of medication for behavioural health conditions.
Read MoreUS panel of health experts advocate early interventions for childhood obesity from age 6
A panel of U.S. health experts has put forth a draft recommendation advocating for children with obesity to begin receiving comprehensive counselling aimed at fostering healthy eating and exercise habits, starting at the age of 6. This guidance, issued by the U.S. Preventive Services Task Force (USPSTF), builds upon their 2017 recommendation which suggested that obesity screening should commence from the same age.
Recent research underscores the value of intensive behavioural interventions, defined as a minimum of 26 hours of counselling with one or more health professionals, in aiding children and adolescents to achieve and maintain a healthy weight and enhance their overall quality of life. However, the recommendation does not set a specific timeframe for these interventions.
The USPSTF’s updated advice does not delve into the use of weight-loss medications like Novo Nordisk’s Wegovy, approved for use in children aged 12 and above, nor does it address surgical options. The Task Force reviewed evidence surrounding weight-loss medications but noted that further research is needed to fully grasp the long-term health impacts of such treatments.
According to Dr. Katrina Donahue from the University of North Carolina School of Medicine and a member of the Task Force, the proposed behavioural interventions encompass a combination of physical activity, behaviour change support, and education on healthy eating. Recognising that available resources vary by location, Donahue acknowledged that the implementation of these interventions might differ across cities.
The recommendation is backed by data from 58 randomised controlled trials involving over 10,000 children, which demonstrated the effectiveness of these interventions when a child engages in at least 26 hours of professional contact. The evidence for these intensive interventions received a “grade B” from the USPSTF, indicating high certainty of at least moderate benefit. The children in these trials lost an average of 4 to 6.5 pounds (approximately 2 to 3 kilograms), with the reductions being sustained for at least a year.
Childhood and adolescent obesity, through the age of 19, is defined as having a body mass index (BMI) – a weight-to-height ratio – higher than that of 95% of peers of the same age and gender. Nearly one in five U.S. children and teenagers are categorised as having obesity, based on data from the U.S. Centers for Disease Control and Prevention (CDC).
The American Academy of Pediatrics (AAP) guidelines also endorse lifestyle support, including over 26 hours of face-to-face, family-based, multicomponent treatment spanning 3 to 12 months. Additionally, the AAP recommends paediatricians consider weight-loss drugs for children with obesity aged 12 and over and to refer adolescents aged 13 and older with severe obesity for metabolic and bariatric surgery evaluation.
The USPSTF’s draft recommendation is open for public comment until the 16th of January 2023, inviting a wider discourse on the proposed approach to tackle childhood obesity.
Read MoreOxford study shows doctors’ communication style crucial for patient weight loss success
A groundbreaking study from the University of Oxford, recently published in the Annals of Internal Medicine, has revealed that the manner in which doctors communicate with patients about obesity plays a pivotal role in their weight loss success. This innovative research delves into the nuances of communication, showing that not only do the words doctors use matter, but also their tone and delivery have a profound impact over both short and long-term patient outcomes in a medical setting.
Conducted by the Nuffield Department of Primary Care Health Sciences, the study analysed 246 recordings of consultations and discovered that even subtle elements like the choice of words and vocal tone significantly affect patient responses. The findings have emerged amidst obesity treatment guidelines urging doctors to initiate weight loss discussions and suggest weight loss services. However, effective communication on this front occurs for only about 5% of those affected annually, indicating a significant gap between policy and practice.
Many doctors express reluctance to broach sensitive topics like obesity due to fears of offending patients or feeling uncertain about handling such discussions. From the patients’ perspective, negative experiences stemming from certain tones or word choices can inadvertently harm the doctor-patient relationship.
This research, funded by the National Institute for Health and Care Research School for Primary Care Research and Foundation for the Sociology of Health and Illness, utilised conversation analysis techniques on audio recordings from the BWel trial. In this trial, doctors offered patients referrals to a 12-week weight loss programme, and the researchers observed how different communicative approaches – categorised as ‘good news’, ‘bad news’, or neutral – influenced patient engagement and satisfaction.
Statistical analysis revealed that patients were more likely to enrol in, attend, and lose more weight in programmes when the referral was framed as ‘good news’. Specifically, 83% of patients offered programmes in a positive light attended, compared to only 50% for neutrally framed offers. Those who received ‘good news’ also lost about half a stone (3.6kg) more compared to the ‘neutral’ or ‘bad’ news groups.
Dr Charlotte Albury, the study’s lead author, emphasised that framing weight loss conversations positively encourages patients to participate more actively in programmes, yielding better weight loss outcomes. She noted that while both ‘neutral’ and ‘negative’ framings led to similar levels of programme acceptance and weight loss, the ‘good news’ approach stood out for its effectiveness.
The study identified specific characteristics of ‘good’ and ‘bad’ news delivery. In the ‘good news’ approach, doctors focused on the benefits of weight loss in an optimistic manner, confidently shared advantages, and communicated fluently and cheerfully. In contrast, the ‘bad news’ framing centred on health issues related to overweight and emphasised patient effort, often marked by slower delivery and hesitations. The neutral approach maintained a steady tone without leaning towards either benefits or issues.
Dr Albury highlighted the importance of these findings for medical professionals, suggesting that adopting a ‘good news’ approach could significantly enhance patient motivation and success in weight management. By transforming discussions into positive and empowering dialogues, doctors can effectively encourage patients to adopt healthier lifestyles.
Read MoreCan cognitive behavioural therapy (CBT) help with weight loss?
Cognitive behavioural therapy (CBT) is a type of talk therapy that focuses on identifying unhelpful thoughts and behaviours and replacing them with more positive and constructive ones.
This therapy aims to help people overcome a variety of issues, including anxiety, depression, phobias, substance use disorders, eating disorders, insomnia, relationships, self-esteem, and personality disorders. CBT is not intended to be ongoing, and typically involves regular sessions with a therapist for anywhere from 4 to more than 20 sessions, depending on the issue being addressed.
CBT can be particularly helpful for people who struggle with weight management, as it focuses on changing the behavioural patterns that contribute to weight gain. For example, if someone tends to overeat in response to stress, CBT can help them develop more positive coping strategies to manage their stress. CBT is also considered a preferred treatment for obesity and binge-eating disorder (BED).
To use CBT for weight loss, a therapist will help an individual set specific and attainable goals, such as reaching a target weight range or adopting a healthier lifestyle. The therapist will also encourage self-monitoring to help the individual become aware of their eating behaviours and to identify potential setback triggers, such as boredom or stress eating.
By identifying these triggers early on, the individual can take steps to correct them and avoid undoing their progress. The therapist may also offer feedback and reinforcement to help the individual stay motivated and track their progress. While CBT can be a highly effective way to change habits and patterns of thinking, it’s important to remember that lifestyle and behavioural training can take time, and progress may not happen overnight.
Read MorePositive parenting can reduce the risk that children develop obesity
Children with positive, early interactions with their caregivers — characterised by warmth, responsiveness, and a stimulating home environment — were at reduced risk of childhood obesity according to new research from Pennsylvania State University in the United States.
The study, “Family Psychosocial Assets, Child Behavioral Regulation, and Obesity,” appeared in the journal Pediatrics. In the article, Brandi Rollins, assistant research professor of biobehavioural health and Lori Francis, associate professor of biobehavioural health, analysed data from over 1,000 mother-child pairs and found that children’s early exposures to family psychosocial assets — including a quality home environment, emotional warmth from the mother, and a child’s ability to self-regulate — reduced the risk of developing childhood obesity.
“A lot of the discussion around childhood obesity and other health risks focuses on identifying and studying the exposure to risk,” said Rollins, “We took a strength-based approach in our analysis. We found that a supportive family and environment early in a child’s life may outweigh some of the cumulative risk factors that children can face.”
An especially encouraging aspect of the study found that these factors were protective even when children faced familial risks for obesity, including poverty, maternal depression, or residence in a single-parent home.
“Research on parenting has shown that these types of family assets influence children’s behaviour, academic success, career, and — not surprisingly — health,” Rollins said. “It is significant that these factors also protect against childhood obesity because the family assets we studied are not food or diet-specific at all. It is heartening to know that, by providing a loving, safe environment, we can reduce the risk that children will develop obesity.”
Children are deemed to have obesity when their body mass indices (BMIs) are greater than 95% of other children their age and gender. There is a great deal of variance, however, in the BMIs of children who exceed the obesity threshold. Children whose BMI is 20% higher than the obesity threshold are considered to have severe obesity.
The researchers found that children who had early-onset severe obesity did not face greater levels of family risk than children who were not obese. Children with severe obesity, however, did have fewer family assets than children who were not obese or who displayed moderate levels of obesity. More research is needed to understand which factors contribute to the development of severe obesity and which factors reduce the risk.
“Though the findings on severe obesity may seem discouraging, they offer some hope,” Rollins explained. “Some risk factors, like household poverty, can be very difficult to change. Assets, on the other hand, may be easier to build. People can learn to parent responsively. It is encouraging that parenting really matters, that family matters.”
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