Dr Arwen Podesta explains her PDT patient selection process and the factors she considers before treatment.
Arwen Podesta, MD: I'm very firm on needing to risk-stratify for what patient is going to do well with what treatment regimen. I want to use the different treatment tools in my toolbox for every patient. If someone has an addiction, a sleep disorder, and irritable bowel [syndrome], I want to use everything that I can to help them get well—not just to treat their addiction if that's what they're seeing me for. Most of the prescription digital therapeutics have an onboarding process that their pharmaceutical company essentially takes over. I have my assistant write the prescription on the portal, the rest of the system moves forward, and I monitor it through the clinician dashboard.
How do I talk to the patient about it? Most of my patients want something to treat their symptoms today so they don't relapse, can maintain better focus, can sleep, or don't have nightmares. We talk about getting underneath—treating the root symptoms and really changing behaviors that go with that. Some are resistant to therapy or “don’t have the time,” but these apps take no more than 1 hour a week if you're doing them at a basic level. We can navigate and negotiate that. I use a lot of motivational interviewing for those that might be resistant. I show them videos and have resources available in my office to share with my patients. Consistency tends to be the barrier for my patients. When I look at my clinician dashboard, if someone hasn't started or hasn't onboarded, I'll send them an email or text, but it doesn't mean they're going to.
How can I choose [adhering] patients? That's a work in progress, but with any addiction treatment, it works if you work it. They work if you use them. There don't seem to be any reported adverse events with any of these vs the many medications that do have risk of adverse events. [This is a place to start for patients that do not want adverse events.]
This transcript has been edited for clarity.