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DTx Can Bridge the Healthcare Gap in Rural Areas in the US—DTx Alliance Report Finds

DTx Can Bridge the Healthcare Gap in Rural Areas in the US—DTx Alliance Report Finds

by Hanna Kurlanda-Witek, PhD

The Digital Therapeutics Alliance (DTA) has published a report1 on how digital therapeutics (DTx) can help minimize the differences between access to healthcare in rural and urban areas in the United States.

The report referred to data from federal programs, which revealed that nation-wide death rates were higher in rural areas than in urban areas and, in the last decade, the gap in these inequalities has widened for five of the seven major causes of death in the United States—chronic obstructive pulmonary disease (COPD), diabetes, coronary heart disease (CHD), cancer, and suicide.2 The outlook is particularly bleak as approximately one in five Americans (circa 60 million people) live in rural areas, many of whom have limited access to healthcare facilities.3,4 

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Leveling disparities with digital technology

DTx are a rapidly evolving branch of healthcare. They focus on the treatment, management, as well as prevention of these life-threatening diseases using a device that 80% of rural Americans own … a smartphone.5 

Sidekick Health recognizes the value of a high-quality, evidence-based DTx solution, which can seamlessly complement in-patient care in rural areas. The use of DTx solutions will continue to grow, improving health outcomes through better patient engagement and real-time monitoring of patients’ health. This will especially impact underserved communities by making it easier for patients to act on various health issues when they occur and get real-time support from their doctors when they’re unable to access healthcare facilities.

Support for cancer patients

According to the DTA report, “Significant disparities exist in cancer care for rural patients, with death rates that are 114% of their non-rural counterparts.”1 This is particularly true for cancers that are preventable through early detection.6 People living in rural areas are more likely to be diagnosed at a later stage, and once they are, report worse health conditions than urban patients. Rural cancer patients also face longer travel times to hospitals and lack supportive services throughout their cancer treatment.7 

While treatment options are increasing and improving for cancer patients, side effects from these treatments can significantly affect patient well-being, sometimes appearing even months or years after therapy.8 Monitoring of these side effects is necessary not only to provide healthcare professionals (HCPs) with information regarding the patient’s health status and reactions to treatment, but it also contributes to research by informing HCPs and pharmaceutical companies about effective ways of administering treatment and what aspects of long-term care need to be improved.

Early and continuous collection of symptoms

Electronic patient reported outcomes (ePROs) supported through Sidekick’s DTx platform are easily accessed by smartphone through the downloadable app. Patients can complete daily questionnaires on a variety of topics, ranging from their energy levels, to mental health status, and treatment symptoms.

What’s crucial is that HCPs can find out about any potential side effects afflicting their patients in real time, and often before they become serious.

This aspect of digital care will make an enormous difference in managing the treatment of patients outside of urban areas who rarely see a specialist between hospital visits.9 

Empowering diabetes patients with tools for health self-management

Approximately 10% of Americans have been diagnosed with diabetes, while nearly one out of three Americans have pre-diabetes.10 Inadequate treatment of this disease may lead to further health complications, such as stroke, high blood pressure, and kidney disease.2 In the United States, people living in rural areas have more risk factors for developing diabetes than those living in non-rural areas: they are more likely to smoke cigarettes, have high blood pressure, and have less time for physical activity.4,11  A resident of a rural area is 30% more likely to die from the disease.2 Due to barriers such as lower numbers of healthcare facilities outside of cities, many people may not be diagnosed at all, and even if they are, support programs that help manage the disease are few and far between.

Lifestyle changes have a considerable effect on the prognosis of many serious diseases, and this is especially evident in patients with type 2 diabetes. Studies have found that weight management can reverse the disease, taking patients off antidiabetic drugs.12 DTx solutions like Sidekick can provide patients with guidance on how to achieve positive lifestyle changes, which could lead to better control of blood sugar levels. A small study conducted by Sidekick, where patients with type 2 diabetes used the Sidekick lifestyle program, demonstrated that use of the app could potentially boost treatment efficacy.13 A larger study conducted by Sidekick, which focused on using the Sidekick platform for weight loss, found that users were more likely to achieve weight loss and complete the treatment program when they used the app.14 

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Changes in public policy will propel the use of DTx in rural areas

DTx are not a blueprint for the future; they are already part of the current healthcare landscape in remote patient monitoring and mental health, which was driven by the COVID-19 pandemic.15

The field will continue to expand at a dynamic pace, and has the potential to be the equalizer between rural and urban treatment options.

In November 2021, the Centers for Medicare and Medicaid Services (CMS) have repealed its final rule on Medicare Coverage of Innovative Technology (MCIT) and Definition of Reasonable and Necessary.16 Public policy is required to meet the needs of patients and care providers by providing a legal framework for DTx products and creating a clinical payment mechanism. Considering the level of innovation that’s already taking place in DTx, the question is not if but when public policy will catch up to extend coverage for these products and put in place adaptable procedures for their commercialization. Additionally, as stated in the DTA report, “DTx products may significantly reduce total cost of care in Medicare.”

Expanding the need for rural access to DTx products

DTx offer an unprecedented healthcare option, particularly to those living in rural communities. Barriers to primary care, such as a long distance to healthcare clinics, underfunded facilities and hospital closures, can be mitigated with the use of affordable, clinically-validated technology that is already in existence and constantly developing. Becoming a partner with Sidekick brings the advantage of quality real-time and remote medical care, putting patient health front and center.

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References

1 Digital therapeutics: reducing rural health inequalities. Digital Therapeutics Alliance. October, 2020. [cited 2022 Feb 23]. Available from: https://dtxalliance.org/wp-content/uploads/2021/01/DTA_Rural-Health_r13_110220.pdf

2 About Healthy People. 2022 [cited 2022 Feb 22]. Available from: https://www.healthypeople.gov/2020/About-Healthy-People

3 One in five Americans live in rural areas. 2017 [cited 2022 Feb 22]. Available from:  https://www.census.gov/library/stories/2017/08/rural-america.html

4 Leading causes of death in rural America. 2019 [cited 2022 Feb 22]. Available from: https://www.cdc.gov/ruralhealth/cause-of-death.html

5 Pew Research Center Mobile Fact Sheet. 2021 [cited 2022 Feb 22]. Available from: https://www.pewresearch.org/internet/fact-sheet/mobile/

6 Yabroff KR, Han X, Zhao J, et al. Rural cancer disparities in the United States: a multilevel framework to improve access to care and patient outcomes. JCO Oncology Practice 2020; 16(7): 409-413 .

7 Mollica MA, Weaver KE, McNeel TS, Kent EE. Examining urban and rural differences in perceived timeliness of care among cancer patients: a SEER-CAHPS study. Cancer 2018; 125(15): 3527-3265.

8 Couey, MA, Bell RB, Patel AA, et al. Delayed immune-related events (DIRE) after discontinuation of immunotherapy: diagnostic hazard of autoimmunity at a distance. J Immunother Cancer 2019; Jul 3;7 (1):165.

9 Diving deep into immune checkpoint inhibitors. 2022 [cited 2022 Feb 22]. Available from: https://sidekickhealth.com/news/diving-deep-into-immune-checkpoint-inhibitors/

10 Centers for Disease Control and Prevention, National Diabetes Statistics Report. 2022 [cited 2022 Feb 22]. Available from: https://www.cdc.gov/diabetes/data/statistics-report/index.html.

11 Tran P, Tran L, Tran L. Impact of rurality on diabetes screening in the US. BMC Public Health 2019 Sep 26;19(1):1190.

12 Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2018 Feb 10;391(10120):541-551.

13 Hilmarsdóttir E, Sigurðardóttir ÁK, Arnardóttir RH. A digital lifestyle program in outpatient treatment of type 2 diabetes: a randomized controlled study. Journal of Diabetes Science and Technology 2020; 1-8.

14 Thorgeirsson T, Torfadottir JE, Egilsson E, et al. Randomized trial for weight loss using a digital therapeutic application. Journal of Diabetes Science and Technology 2021; 1-9.

15 Modernizing Medicare coverage pathways for prescription digital therapeutics. 2021 [cited 2022 Mar 6]. Available from: https://www.healthaffairs.org/do/10.1377/forefront.20210510.303135/full/

16 Medicare Program: Medicare Coverage of Innovative Technology and Definition of Reasonable and Necessary. 2021 [cited 2022 Feb 22]. Available from: https://www.regulations.gov/document/CMS-2020-0098-0676