Abstract
Background: Integrated care is essential to achieving universal health coverage, especially for underserved populations. Workforce shortages in mental health services and long waiting times particularly hinder individuals with mild conditions, who often receive limited support. Digital health innovations, like digital therapeutics (DTx), in an integrated care perspective, present opportunities to expand access, streamline care, and optimize resources within local healthcare systems.
Our study addresses key challenges in mental health care delivery:
i) Limited Access: Patients with mild mental health conditions face barriers to appropriate care, as resources are primarily directed to moderate and severe cases, leaving gaps in services for low-risk patients.
ii) Lack of Integrated Pathways: Currently, no coordinated pathways exist for mental health care. General practitioners (GPs) and specialists have limited communication options, resulting in fragmented care.
iii) Barriers to Integrated Care: Resource constraints and siloed care structures hinder care integration. Digital health technologies thus remain largely confined to pilot projects, limiting their benefits in mainstream health services.
Approach: This methodology aims to implement a digital, stepped-care framework that leverages DTx within an integrated care model, addressing these challenges in a structured way. Key motivations include:
i) Stepped-Care: By organizing care into levels based on patient needs, this approach provides scalable, targeted interventions across the risk spectrum, from self-directed support for low-risk patients to monitored, semi-guided engagement for those with moderate needs. Stepped care supports efficient resource allocation and reduces the pressure on mental health specialists.
ii) Digital Platform: The TreC public digital platform [1] serves as a central digital health tool with both, a user mobile app front-end and a clinical interface. It enables GPs to prescribe DTx, monitor patient progress, and manage referrals across sectors, fostering continuity across prevention, primary and specialized care. For patients, TreC provides education and information on prevention and self-help resources, guided DTx, and engagement tools for proactive mental health management.
iii) DTx for Expanded Reach: DTx enables patients to receive mental health support in rural areas and frees specialists to focus on cases requiring direct intervention. This promotes equitable access to mental health care while addressing healthcare capacity constraints.
Results: The implementation of this methodology in Trentino is anticipated to address mental health needs for low-to-moderate cases by adopting DTx. By facilitating access to remote, scalable interventions, this approach optimizes specialists’ time and extends care to underserved areas. A clinical study is underway to evaluate whether combining stepped care with DTx improves care coordination, reduces service bottlenecks, and enhances patient engagement. The evidence gathered will inform other regions on the potential of adapting this framework with limited resources.
Implications: By implementing DTx into an integrated health model based on a stepped-care framework, this methodology provides the means for delivering accessible mental health support even in resource-constrained systems. Insights from Trentino and Scotland contribute to broader discussions on integrated mental health care, offering a replicable model to inform policies for universal health coverage.
Reference: [1] Eccher C et al.TreC platform. J Biomed Inform. 2020; doi: 10.1016/j.jbi.2019.103359.