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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

朱婷, 黄亚芳, 相彤, 吴浩. 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[J]. 中华全科医学, 2024, 22(3): 357-360. doi: 10.16766/j.cnki.issn.1674-4152.003402
引用本文: 朱婷, 黄亚芳, 相彤, 吴浩. 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[J]. 中华全科医学, 2024, 22(3): 357-360. doi: 10.16766/j.cnki.issn.1674-4152.003402
ZHU Ting, HUANG Yafang, XIANG Tong, WU Hao. Application and prospects of cognitive-behavioral therapy based digital therapeutics of chronic disease management in the community[J]. Chinese Journal of General Practice, 2024, 22(3): 357-360. doi: 10.16766/j.cnki.issn.1674-4152.003402
Citation: ZHU Ting, HUANG Yafang, XIANG Tong, WU Hao. Application and prospects of cognitive-behavioral therapy based digital therapeutics of chronic disease management in the community[J]. Chinese Journal of General Practice, 2024, 22(3): 357-360. 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
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

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

  • 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。

     

  • 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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  • 收稿日期:  2023-11-28
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