基于认知行为治疗的数字疗法在社区慢性病管理中的应用及展望

朱婷; 黄亚芳; 相彤; 吴浩

doi:10.16766/j.cnki.issn.1674-4152.003402

基于认知行为治疗的数字疗法在社区慢性病管理中的应用及展望

doi: 10.16766/j.cnki.issn.1674-4152.003402

首都医科大学全科医学与继续教育学院，北京 100069

基金项目:

北京市高层次公共卫生技术人才培养计划 2022-1-005

详细信息

通讯作者:
黄亚芳，E-mail：yafang@ccmu.edu.cn

中图分类号: R197.61 R45
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- 文章访问数: 270
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- 被引次数: 0
出版历程
- 收稿日期: 2023-11-28
- 网络出版日期: 2024-05-27

Application and prospects of cognitive-behavioral therapy based digital therapeutics of chronic disease management in the community

School of General Practice and Continuing Education, Capital Medical University, Beijing 100069, China

摘要

摘要: 数字疗法作为由高质量软件程序驱动、有效且安全的新兴干预手段，正逐渐应用于基层临床实践。认知行为治疗(CBT)是心理治疗领域应用最广泛的经典方法，也是诸多数字疗法产品中的关键核心技术。传统CBT干预技术的实施通常存在治疗场所及专业人员不足的局限，无法普及到更广泛的目标人群。借助数字疗法，将CBT技术融入相应设计模块，可突破上述局限。目前CBT-数字疗法产品在基层慢性病防治领域主要应用在患者生活方式干预及以人为中心的照顾方面，其在常见慢性病健康监测及预防、疾病治疗和优化药物治疗效果方面的应用尚存在较大的开发空间。作为引领基层医疗服务质量高效推进、满足主动健康科技发展的重要支撑，CBT-数字疗法获得了政策环境大力的支持、新兴科技的全面赋能以及慢性病患者自我健康管理意愿的带动，迎来了关键发展机遇。同时，CBT-数字疗法未来还存在一些亟待突破和完善的关键点。今后需注重符合监管需要的临床数据的积累，基于患者慢性病数据、利用算法技术，进一步精准定位患者的个性化需求，以拓宽CBT-数字疗法慢性病管理适应证。同时，需进一步完善数字疗法相关监管法规，制定与数字疗法产品相适应的审批制度，并完善CBT-数字疗法产品数据的安全性、隐私保护、医保支付政策等方面的行业标准。
- 数字疗法 /
- 认知行为治疗 /
- 基层医疗 /
- 慢性病管理 /
- 循证医学
Abstract: Digital therapeutics, as an emerging effective and safe intervention driven by high-quality software programs, are increasingly being used in primary care based clinical practice. Cognitive-behavioral therapy (CBT) is the most widely used classical approach in psychotherapy and is also a core technology in many digital therapeutics products. CBT interventions are usually limited by the lack of treatment space and professionals, which makes it impossible to reach out to a wider target group of patients. With the help of digital therapeutics, CBT technology can be integrated into the corresponding design module to break through these limitations. At present, CBT-digital therapeutics products are mainly used in the field of primary chronic disease prevention and treatment in the field of lifestyle intervention and patient-centered care, and there is still a large development potential for their application in health monitoring and prevention of common chronic diseases, disease treatment and optimization of drug treatment effects. As an important support to lead the efficient promotion of the quality of primary care services and meet the development of active health technology, CBT-digital therapeutics have ushered in key development opportunities driven by the strong support of the policy environment, the comprehensive technological innovation empowered by emerging technologies, and the increased willingness of patients with chronic diseases to manage their health. At the same time, there are still some key points that need to be broken through and improved in the future of CBT-digital therapeutics. In the future, it is necessary to pay attention to the accumulation of clinical data that meets the needs of supervision, and use algorithm technology to further accurately locate the personalized needs of patients based on patients ' chronic disease data, so as to broaden the indications for chronic disease management of CBT-digital therapeutics. At the same time, it is necessary to further improve the regulatory regulations related to digital therapeutics, formulate an approval system suitable for digital therapeutics products, and improve industry standards in terms of data security, privacy protection, and medical insurance payment policies.
- Cognitive-behavioral therapy /
- Digital therapeutics /
- Primary care /
- Chronic disease management /
- Evidence-based medicine

HTML全文

表 1 传统CBT与CBT-数字疗法的局限与优势

Table 1. Limitations and advantages of traditional CBT versus CBT-digital therapy

项目	传统CBT的局限	CBT-数字疗法的优势
可及性	因专业医疗资源(人力、物力、时间等)紧张造成CBT技术干预可及性欠佳。	通过手机、电脑等设备实现远程干预，包括患者独自使用或在专业医疗人员的协助下进行CBT-数字疗法干预。
连续性	拥有不良生活方式的群体可能存在治疗依从性不强、治疗不连续、失访率高等情况。	数字疗法能提升患者的治疗依从性，提供连续性照顾，在降低慢性病患者失访率方面的优势已被证实。
协调性	在提供治疗时，传统CBT团队内部、各团队间的协调通常受到物理空间、资源不足等方面的限制。	其开发模块具备协调各方面资源的功能，打破地理位置限制，大数据算法的支撑有助于合理优化资源分配。
循证医学支持	尽管传统CBT也可依靠数字健康，但对健康行为的干预效果缺乏证据支持。	CBT-数字疗法是基于数字疗法的干预措施，经过了严格的循证医学评价。
医疗花费	传统CBT通常需要较高的花费，当医疗保险不能覆盖时，会加重患者经济负担。	数字疗法的研发需要前期投入，但其后续在临床中的应用可极大地降低患者往返医疗机构的频率，节约时间成本，远期也可降低慢性病患者的医疗花费。
个人隐私保护	慢性病患者可能因其自身情况(例如合并药物滥用、精神疾病等)对其隐私有所顾虑，在与医生单独面对面沟通方面存在顾虑。	CBT-数字疗法可在隐匿患者部分信息(例如相貌、体态特征等)的前提下实现远程干预，最大限度地降低面对面沟通的需要，利用数据安全技术保护患者个人隐私。

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