Overall summary
Health Innovation Oxford and Thames Valley (HIOTV) worked with Otsuka Pharmaceutical Europe to understand how their digital therapeutic, Rejoyn (formerly known as CARE for MDD), could most effectively be embedded within NHS patient pathways.
Rejoyn is a digital therapeutic intended for the treatment of depressive disorder episodes in adults. It is intended to be used alongside usual care provided by a Healthcare Professional. Rejoyn addresses all three of the government’s three priority shifts.
We conducted a feasibility study and engaged with key stakeholders in the NHS depression pathway to assess the clinical need, perceived potential benefits, acceptability and barriers to adoption. We also designed and delivered a pilot across primary care.
In order to do this, we:
- Recruited NHS sites to offer CARE for MDD to eligible patients
- Engaged clinical champions and patient representatives to guide delivery
- Collected and analysed feedback from both patients and healthcare professionals through interviews and usage data
- Gathered insights and identified practical barriers and enablers to adoption in different care settings
What is the challenge?
Almost two million people are referred by their GP to NHS Talking Therapies services every year. More than one million contacts are made with these services annually. Not all people with depression respond to current treatments. New treatments could meet the needs of more patients.
- NHS mental healthcare is under high and increasing pressure, driven by growing demand (including from economic and social factors), and pressures in both primary and secondary care which are unlikely to abate in the short to medium term.
- There is significant unmet need across the UK in anxiety and depression, particularly among specific patient cohorts.
- The rise in demand is likely to continue given ongoing social and economic trends and changing attitudes to mental health.
- Both service providers and patients are seeking non-pharmaceutical alternatives for the treatment of depression.
What did we do?
We carried out a feasibility study to gain an understanding of the clinical need for CARE for MDD in the NHS depression pathway and to collect views of clinicians on the perceived usefulness, its level of acceptance and potential barriers to adoption. Our findings from the feasibility study led on to our delivery of a pilot across primary care. Facilitating patient and public involvement was crucial to this and involved three steps:
- Patient and public representation on the Project Advisory Board
- Patient engagement workshop
- The aim of the workshop was to gather insight into the barriers and facilitators to accessing a digital treatment, gain feedback on the proposed code distribution process for accessing CARE for MDD and review a first draft of the patient literature documents. Nine participants attended the half day workshop, a mix of clinicians, third sector and people with lived experience.
- One-to-one patient interviews with consenting patients with experience of using CARE for MDD during this pilot
- Semi-structured interviews lasting up to one hour were conducted online. Interview questions were informed by the lived experience member of the steering group, expertise and insight from HIOTV and information requested by Otsuka. Interview questions explored overall experience, content and usability of the app to elicit challenges and suggestions for potential improvements.
Involving healthcare professionals (HCPs) and recruiting pilot sites was crucial in helping to explore and understand the fit and applicability of CARE for MDD.
A real-world evaluation where CARE for MDD was offered to patients was supported by interviews with the HCPs who were involved, to gather their insights on the value that CARE for MDD brought to both the healthcare system and to the patients themselves.
Findings
The pilot showed that primary care is the most suitable setting to offer a digital therapeutic for treating depression. GPs have greater flexibility in the treatments they can provide, and more patients could benefit.
Patients valued having a digital option they could start using quickly, especially as an alternative to medication. Clinicians saw potential for it to fill a gap in support for those with mild to moderate symptoms.
Some challenges were identified around tailoring patient information for the UK context and ensuring users receive regular clinical reviews during use. Findings from this project suggest that to maximise the clinical and commercial value and to give patients the highest level of support possible from the start, it should be offered via primary care to patients who have an existing diagnosis of depression, but challenges exist in the tension between the amount of support that patients want / expect and that which GPs / HCPs are able to offer.
Findings also suggested that digital treatments like this could have a significant contribution towards the NHS net zero ambition with around one-quarter of the carbon impact of traditional face-to-face care.
HIOTV made recommendations to Otsuka for the positioning and support of the UK rollout of Rejoyn.
What people said
“Through working in collaboration with Health Innovation Oxford and Thames Valley we have gained valuable insights into navigating NHS pathways which has heavily influenced the commercial launch of Rejoyn in the UK. The learnings, advice, support and guidance received from the team and the delivery of a pilot across primary care has led to a successful product launch and have helped contribute to Rejoyn being available to the NHS as part of a commissioned service.”
Simon Wake, Digital Health Implementation Lead, Otsuka
“This project was incredibly valuable to us as it provided insights that allowed us to plan our next steps effectively to ensure we can meet the expectations of the clinical stakeholders in the NHS. I very much appreciated the expertise that HIOTV provided and look forward to continuing to work with the team on future activities.”
Elcie Chan, EU Commercial Director – Digital Health, Otsuka
Contact
Florence Serres, Project Manager florence.serres@healthinnovationoxford.org