Contributors |
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xi | |
Foreword |
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xiii | |
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1 Introduction: A vision for the field of digital therapeutics |
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1 | (4) |
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1 | (1) |
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1.2 Who is this book for? |
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1 | (1) |
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1.3 What topics are covered in this book? |
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1.3.1 First section: Introduction to digital therapeutics |
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2 | (1) |
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1.3.2 Second section: The new frontier |
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2 | (1) |
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1.3.3 Third section: Structural considerations |
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3 | (1) |
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1.4 What will readers learn? |
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3 | (2) |
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2 Using digital therapeutics to target gaps and failures in traditional mental health and addiction treatments |
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5 | (14) |
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2.1 Prevalence and impact of mental health and substance use disorders |
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5 | (1) |
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2.2 Lack of treatment receipt in the traditional care system |
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5 | (2) |
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2.3 Barriers to traditional treatment: stigma, personal beliefs, and cultural competence |
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7 | (1) |
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2.4 Barriers to traditional treatment: cultural competence |
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7 | (1) |
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2.5 Barriers to traditional treatment: high cost and lack of insurance coverage |
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7 | (1) |
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2.6 Barriers to traditional treatment: transportation and appointment time availability |
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8 | (1) |
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2.7 Barriers to traditional treatment: inadequate number of mental health providers |
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8 | (2) |
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2.8 Barriers to traditional treatment: patient narratives |
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10 | (1) |
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2.9 Leveraging digital therapeutics to transform treatment models for mental health and substance use disorders |
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10 | (2) |
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2.10 A time of opportunity to transform models of mental health and substance use care via digital therapeutics |
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12 | (7) |
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13 | (6) |
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3 First wave of scalable digital therapeutics: Internet-based programs for direct-to-consumer standalone care for mental health and addiction |
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19 | (12) |
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3.1 Development of internet-based programs |
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19 | (2) |
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3.1.1 Internet-based programs versus mobile applications |
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20 | (1) |
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3.2 Internet-based programs for substance use disorders |
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21 | (2) |
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3.2.1 Therapeutic education system |
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21 | (1) |
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3.2.2 The CHESS-ACHESS program |
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22 | (1) |
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22 | (1) |
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3.2.4 Dual diagnosis patients |
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22 | (1) |
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3.2.5 Prevention and screening |
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22 | (1) |
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3.3 Internet-based programs for mental health (nonsubstance related disorders) |
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23 | (2) |
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3.3.1 Mood and anxiety disorders |
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23 | (2) |
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3.4 Summary and next steps for internet-based programs for substance use and mental health disorders |
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25 | (6) |
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26 | (5) |
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4 Second wave of scalable digital therapeutics: Mental health and addiction treatment apps for direct-to-consumer standalone care |
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31 | (14) |
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4.1 Overview of second-wave digital therapeutics |
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31 | (1) |
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4.2 Evidence base for second wave digital therapeutics |
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31 | (6) |
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4.2.1 Evidence base for mood tracking apps |
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35 | (1) |
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4.2.2 Evidence base for online peer communities |
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36 | (1) |
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4.2.3 Evidence base for serious games |
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36 | (1) |
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4.3 Cautions and limitations with second-generation digital therapeutics |
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37 | (1) |
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4.4 How to find effective second-wave digital therapeutics |
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38 | (1) |
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4.5 How to use second-wave digital therapeutics in practice |
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38 | (1) |
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4.6 Summary and future directions |
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39 | (6) |
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40 | (5) |
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5 Blending digital therapeutics within the healthcare system |
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45 | (20) |
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45 | (1) |
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5.2 Blended care terminology |
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46 | (2) |
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5.2.1 Internet-delivered treatments |
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46 | (1) |
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47 | (1) |
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5.3 Components and structure of blended care |
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48 | (1) |
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5.3.1 Therapeutic support |
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48 | (1) |
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48 | (1) |
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5.3.3 Structure of blended care |
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48 | (1) |
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5.4 Blended care treatment approaches |
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49 | (1) |
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5.5 Development and value of blended care |
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50 | (2) |
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5.5.1 Development of blended care treatments |
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50 | (1) |
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5.5.2 Value of blended care |
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51 | (1) |
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52 | (5) |
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5.6.1 Examples of blended care interventions for MHD adapted for the use in the healthcare system |
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52 | (3) |
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5.6.2 Examples of BC interventions for SUD adapted for use in the healthcare system |
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55 | (2) |
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5.7 Challenges to the adoption of blended care |
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57 | (1) |
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5.8 Future directions and conclusions |
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58 | (7) |
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59 | (6) |
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6 Receptivity to mobile health interventions |
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65 | (12) |
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65 | (1) |
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6.2 The anatomy of an "ideal" mobile health intervention |
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66 | (1) |
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6.3 Key processes of receptivity: receiving, processing, and using support |
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67 | (2) |
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6.4 What do we already know about states of receptivity? |
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69 | (3) |
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6.5 Challenges and future work |
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72 | (5) |
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73 | (4) |
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7 Adapting just-in-time interventions to vulnerability and receptivity: Conceptual and methodological considerations |
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77 | (10) |
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77 | (1) |
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7.2 Just-in-time adaptive interventions |
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78 | (1) |
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78 | (1) |
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7.4 States of vulnerability and receptivity |
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79 | (1) |
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7.5 Scientific questions about vulnerability and receptivity in just-in-time intervention development |
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80 | (1) |
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7.6 Analyzing observational ILD to inform JITAI development |
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80 | (3) |
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7.7 Analyzing ILD from microrandomized trials |
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83 | (2) |
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85 | (2) |
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85 | (1) |
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85 | (2) |
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8 A digital therapeutic alliance in digital mental health |
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87 | (12) |
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87 | (1) |
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8.2 What is therapeutic alliance? |
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87 | (1) |
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8.3 Applying therapeutic alliance to DMHIs: digital therapeutic alliance |
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88 | (1) |
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8.4 Defining digital therapeutic alliance |
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88 | (1) |
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8.5 Differences in DTA across interventions |
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89 | (1) |
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8.6 DTA in supported interventions |
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90 | (1) |
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8.7 DTA in unsupported interventions |
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90 | (2) |
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92 | (1) |
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92 | (1) |
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93 | (1) |
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93 | (1) |
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8.12 Future directions and recommendations |
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94 | (1) |
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95 | (4) |
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95 | (4) |
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9 Conversational agents on smartphones and the web |
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99 | (14) |
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99 | (2) |
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99 | (1) |
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9.1.2 Advantages of conversational agents |
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99 | (1) |
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9.1.3 Disadvantages of conversational agents |
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100 | (1) |
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101 | (1) |
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9.2 Conversational agents on the web |
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101 | (3) |
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9.2.1 Barriers to use for web-based CAs |
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101 | (1) |
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9.2.2 Text-based CA interventions on the web |
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102 | (1) |
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9.2.3 ECA-based interventions on the web |
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103 | (1) |
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9.3 Conversational agents on smartphones |
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104 | (3) |
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9.3.1 Text-based CA interventions on smartphones |
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107 | (1) |
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9.3.2 ECA-based interventions on smartphones |
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107 | (1) |
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9.4 Safety issues in using conversational agents |
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107 | (1) |
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108 | (1) |
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109 | (4) |
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109 | (4) |
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10 Voice-based conversational agents for sensing and support: Examples from academia and industry |
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113 | (22) |
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113 | (3) |
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10.1.1 VCAs to relieve the healthcare system |
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113 | (1) |
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10.1.2 The advantages of voice modality |
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114 | (1) |
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10.1.3 VCAs to provide engaging digital health interventions |
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115 | (1) |
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116 | (1) |
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10.2.1 Included and excluded cases |
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116 | (1) |
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10.2.2 Technical implementation |
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116 | (1) |
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10.2.3 Sensing and support |
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116 | (1) |
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10.2.4 Explorative approach |
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117 | (1) |
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117 | (8) |
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10.3.1 Simple active sensing prototypes |
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119 | (1) |
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10.3.2 Simple passive sensing research |
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120 | (1) |
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10.3.3 Simple passive sensing products |
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121 | (1) |
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10.3.4 Simple reactive health support research |
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122 | (1) |
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10.3.5 Simple reactive health support products |
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123 | (1) |
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10.3.6 Multidimensional health prototypes and products |
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124 | (1) |
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10.4 Most prevalent features and trends |
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125 | (2) |
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125 | (1) |
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10.4.2 Reactive support is easier to implement |
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125 | (1) |
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10.4.3 Active sensing requires costly regulations compliance and good speech recognition |
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125 | (1) |
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10.4.4 Passive sensing requires extensive and rigorous data collection |
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126 | (1) |
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10.4.5 Concerns around data and conversation privacy |
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126 | (1) |
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10.4.6 Amazon Alexa seems to rule the market |
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127 | (1) |
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10.5 Conclusion and outlook |
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127 | (8) |
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128 | (7) |
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11 Design considerations for preparation, optimization, and evaluation of digital therapeutics |
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135 | (16) |
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135 | (1) |
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11.1.1 Overview of chapter |
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135 | (1) |
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11.2 A framework for designing and evaluating digital therapeutic interventions |
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136 | (2) |
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11.2.1 What do we mean by design? |
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136 | (1) |
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11.2.2 The importance of optimization for digital therapeutic design |
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136 | (1) |
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11.2.3 A conceptual framework for informing design decisions |
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137 | (1) |
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11.3 Design considerations for intervention development |
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138 | (5) |
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11.3.1 Phase 1: formative work |
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138 | (1) |
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11.3.2 Phase 2: optimizing intervention design and deployment |
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139 | (4) |
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11.4 Design considerations for short-term & long-term efficacy, effectiveness, and implementation |
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143 | (3) |
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11.5 Discussion and conclusion |
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146 | (5) |
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147 | (4) |
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12 Cultural adaptations of digital therapeutics |
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151 | (14) |
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151 | (1) |
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12.2 Global burden of mental illness and need for cultural adaptation |
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152 | (1) |
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12.3 Methods of cultural adaptation |
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153 | (2) |
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12.4 Cultural adaptation of digital interventions |
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155 | (3) |
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12.5 Recommendations for applying cultural adaptations to digital therapeutics |
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158 | (2) |
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160 | (5) |
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160 | (1) |
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160 | (1) |
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160 | (5) |
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13 Building the digital therapeutic industry: Regulation, evaluation, and implementation |
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165 | (12) |
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13.1 A new category of medicine |
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165 | (1) |
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13.2 Digital Therapeutics Alliance |
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165 | (1) |
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13.3 Industry progression |
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165 | (1) |
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13.4 2017-2021: Foundation building |
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166 | (6) |
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166 | (1) |
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13.4.2 Digital therapeutic definition |
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167 | (1) |
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13.4.3 DTx core principles & best practices |
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167 | (1) |
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13.4.4 Intended use & mechanism of action |
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168 | (1) |
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13.4.5 DTx product categorization |
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168 | (1) |
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13.4.6 Regulatory frameworks |
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168 | (3) |
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13.4.7 Industry's expanding value |
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171 | (1) |
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13.5 2022 & beyond: Equipping decision-makers and end-users |
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172 | (3) |
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13.5.1 Harmonized evaluation frameworks |
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173 | (1) |
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13.5.2 Global recognition & utilization |
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173 | (1) |
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13.5.3 National policy development |
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173 | (1) |
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13.5.4 Clinical guideline & practice inclusion |
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174 | (1) |
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13.5.5 Personalized therapies |
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174 | (1) |
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175 | (2) |
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175 | (2) |
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14 Potential pitfalls and lessons learned |
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177 | (12) |
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14.1 If you build it, we will come, but we may not stay |
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178 | (1) |
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179 | (1) |
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14.3 Access does not equal uptake |
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180 | (2) |
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14.4 A "lift-and-shift" approach does not work |
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182 | (1) |
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14.5 A blended model of treatment is needed |
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183 | (1) |
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14.6 Multidimensional, theory-informed implementation models are needed |
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183 | (2) |
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14.7 A more responsive research and development cycle is needed |
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185 | (1) |
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185 | (4) |
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185 | (4) |
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15 Privacy and security in digital therapeutics |
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189 | (16) |
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189 | (1) |
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15.2 Background on privacy and security in digital therapeutics |
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189 | (4) |
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15.2.1 Digital health ecosystem |
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189 | (1) |
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15.2.2 Security and privacy risks in digital mental health |
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190 | (3) |
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15.3 Relevant security and privacy regulations |
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193 | (2) |
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15.3.1 United States regulations |
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193 | (1) |
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15.3.2 European regulations |
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194 | (1) |
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194 | (1) |
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15.4 Addressing privacy and security concerns |
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195 | (3) |
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15.4.1 Privacy and/or security evaluation frameworks and tools |
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195 | (1) |
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15.4.2 Security and/or privacy evaluation techniques |
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195 | (1) |
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15.4.3 Security and/or privacy design practices |
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196 | (1) |
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15.4.4 Usability and interaction design |
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197 | (1) |
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198 | (7) |
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198 | (7) |
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16 Ethical considerations of digital therapeutics for mental health |
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205 | (12) |
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205 | (1) |
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16.1.1 Setting the context |
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205 | (1) |
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16.1.2 What this chapter does and does not |
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205 | (1) |
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16.2 Ethical issues arising from digital therapeutics in mental health |
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206 | (8) |
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16.2.1 Issues directly affecting patients using digital therapeutics |
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206 | (4) |
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16.2.2 Societal concerns arising from digital therapeutics |
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210 | (3) |
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16.2.3 Health care professionals |
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213 | (1) |
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214 | (1) |
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214 | (3) |
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214 | (3) |
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17 A look forward to digital therapeutics in 2040 and how clinicians and institutions get there |
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217 | (36) |
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217 | (1) |
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17.2 Technology's role in shifting care: market pull from users and the push from artificial intelligence |
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218 | (7) |
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17.2.1 People empowered by mobile technologies |
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218 | (1) |
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17.2.2 The research and planning enabling the shift |
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218 | (7) |
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17.3 A look at how users' experience of care and clinical workflow will change by 2040 |
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225 | (2) |
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225 | (1) |
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17.3.2 Evolution of the healthcare team |
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225 | (1) |
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17.3.3 Interprofessional teamwork |
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226 | (1) |
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17.3.4 Technology and active learning |
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226 | (1) |
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17.3.5 Workflow practices on the rise |
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227 | (1) |
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17.4 Using technology for integrating care |
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227 | (13) |
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17.4.1 Technology training (competencies) and evaluation |
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228 | (12) |
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17.4.2 Digital and cultural literacy |
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240 | (1) |
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17.5 System and institutional shifts for 2030-2040 |
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240 | (3) |
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240 | (1) |
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240 | (2) |
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17.5.3 Financing, reimbursement, and licensing |
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242 | (1) |
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17.5.4 Institutional competencies |
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243 | (1) |
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243 | (2) |
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245 | (8) |
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246 | (1) |
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246 | (1) |
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246 | (7) |
Index |
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253 | |