Contributed: Shortcomings and opportunities for health equity in pediatrics

Children and young people throughout the United States continue to face some of the biggest hurdles to receiving timely and appropriate healthcare. As incidence rates of mental health and complex medical conditions rise, the majority of treatment-seeking children face strained health systems, limited affordable treatment options and care that is not personalized to their unique social, cultural and developmental needs.

While digital health solutions have begun to offer some hope, there remains a disconnect between innovators and the health systems that they are solving for, resulting in products that do not fit clinical workflows, fail to meet the diverse needs of pediatric patients and ultimately struggle commercially.

Meeting user needs

A 15-year-old tells her doctor that she feels anxious. The doctor completes a brief assessment and diagnoses the patient with panic disorder. The doctor offers to write a prescription for an anti-anxiety medication and refers the patient to behavioral health services. The patient doesn’t want to start taking medication, so she elects to be matched with a behavioral health service provider and is placed on a wait list.

Digital health technologies offer new forms of hope to young people and their families. Digital health interventions and telehealth are increasing access to mental health and primary care services, making it easier for patients to find support when and where they need it. 

To ensure that the right patients have access to the right technologies, hospitals are employing tools like AI to streamline patient referrals, provide more accurate diagnoses and gain insights into patient health trajectories that help them better predict and intervene appropriately. Since more still needs to be done to improve outcomes, reduce costs and improve the shortcomings of digital health solutions in pediatric care, healthcare leaders from across the country are calling for greater attention to this space.

After struggling to find a therapist for a few months, the patient returns to her doctor. The doctor decides that the patient is a candidate for a new digital therapeutic. After getting set up with the app, the patient goes home and begins her treatment journey, only to find that the app doesn’t seem relatable – and worse – isn’t translated into her preferred language, making it difficult to comprehend. After a few days of trying it, she stops using the app.

Incidence rates of mental health conditions, such as depression and anxiety, continue to rise throughout the United States, alongside the complexity of optimally treating patients with diverse needs. As the racial and ethnic makeup of the United States continues to diversify, many families find it difficult to receive culturally competent care, raising the risk of negative health outcomes.

At a time when patients and families are increasingly amenable to integrating digital solutions into their care experiences, their specific needs and requirements are often not being met. While digital health can address some of the most pressing issues of patient care, cohesive best practices for developing inclusive, culturally competent and ultimately equitable solutions are largely absent.

To ensure continuity of care, the doctor would like to check their patient’s progress in the app and monitor any change in symptoms over time. While a dashboard exists to view this information, it is not integrated into the existing electronic health record system. Since this product is not interoperable with existing infrastructure, the provider is unable to use the dashboard and must wait to check in with their patient at her next six-month checkup. Rather than streamlining the provider’s process, the digital solution becomes yet another cog in their system.

Digital solutions have the potential to improve patient outcomes and supplement care. However, real challenges exist to their integration into clinical workflows and patients’ daily lives. Rather than delivering on the promise of streamlined care, digital solutions often cause fragmentation and interference in clinician’s work, because their input and perspectives are unaccounted for. Without taking the unique needs of patients and clinicians into account, digital health solutions will see low uptake, activation rates and ultimately struggle to succeed at scale.

Systematic barriers

The patient returns to the doctor after giving up on the app, saying that it was too complicated and difficult to understand. Fortunately, the doctor remembers learning about another app, one that is specifically designed for younger patients and delivers its content in various languages. However, this app isn’t covered by the patient’s insurance and its out-of-pocket expense is too much for the family to afford. Left without a timely and appropriate treatment option, the patient risks worsening symptoms and long-term implications if her struggle to find care persists.

Even if solutions intended for children are built accordingly, they often have a difficult time succeeding on the market. Struggles like this suggest that commercial incentives for pediatric digital health solutions are misaligned. Payers are hesitant to reimburse products with limited real-world evidence, while clinicians and health systems are inundated with a plethora of solutions but feel underprepared to adopt them. Ultimately, children and their families are left with a murky picture of which digital health solutions are available to them and how to pay for them.

Solving these challenges

Digital solutions promise to solve some of the most challenging aspects of care delivery, increase access and improve quality of life. However, when encountered in real settings, these tools often fail to meet diverse patient needs, do not integrate easily into clinical workflows and struggle to define real-world benefits. Ultimately, this perpetuates a cycle of inequitable and fragmented solutions that have no clear path to commercial success.

Delivering on the promise of digitization of pediatric care requires collaborative efforts between stakeholders, including clinicians, researchers, technology companies, investors, payers, policymakers and regulatory bodies.

Ian is a program lead at the Digital Medicine Society, where he leads a multi-stakeholder effort to create The Playbook: Pediatric Digital Medicine, an open access, action-oriented resource intended to catalyze innovation in pediatric healthcare. He has a background in research, operations and strategy related to medical devices and mental health, and is passionate about improving the lives of young people.



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