Selection of PDT patients

Dr. Arwen Podesta explains her process for selecting PDT patients and the factors she considers before treatment.

Arwen Podesta, MD: I am very firm on the need to stratify risks for what the patient will do well with which treatment regimen. I want to use the different treatment tools in my toolbox for each patient. If someone has an addiction, a sleep disorder and an irritable bowel [syndrome], I want to use everything I can to help them recover, not just to treat their addiction if that’s what they’re seeing me for. Most prescription digital therapies have an onboarding process that their pharmaceutical company basically takes care of. I ask my assistant to write the prescription on the portal, the rest of the system moves forward and I monitor it via the clinician’s dashboard.

How to tell the patient? Most of my patients want something to treat their symptoms today so they don’t relapse, can focus better, can sleep or have nightmares. We’re talking about going below, addressing the core symptoms and really changing the behaviors that go along with it. Some are resistant to therapy or “don’t have time”, but these applications take no more than an hour per week if you use them at a basic level. We can navigate and negotiate that. I use a lot of motivational interviewing for those who 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 onboarded, I’ll email or text them, but that doesn’t mean they will.

how can i choose [adhering] the patients? It’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 side effects with any of these drugs compared to the many drugs that have a risk of side effects. [This is a place to start for patients that do not want adverse events.]

This transcript has been edited for clarity.

Martin E. Berry