This article is part of a series sponsored by HLTH that highlights HLTH meeting November 13-16 in Las Vegas.
Clinicians used to wonder if mindfulness meditation had a role in healthcare. But after the Covid-19 pandemic exposed overwhelming demand for practical solutions to behavioral health, the question has shifted to what role it can play.
The answer keeps getting longer.fast Search ClinicalTrials.gov Reveals 700 active clinical trials studying mindfulness in women’s health, insomnia, opioid use disorder, cancer treatment, recovery after surgery, primary care, physical therapy, and more.
In addition to conducting research, digital health companies and healthcare providers are collaborating on how to get apps into the hands of more people.
digital health companies such as calm, headspaceand practice Working with providers and payers to make their app more accessible to patients. Clinicians are referring patients to these apps, and some health systems and payers have developed digital formularies that enable patients to download these and related apps themselves.
So what is mindfulness meditation, also known as mindfulness-based stress reduction?One Articles from the American Physical Therapy Associationquote American Mindfulness Research Associationdescribes mindfulness as the practice of remembering to observe moment-to-moment experiences with an open mind, rather than automatic patterns of previously conditioned thoughts, emotions, or behaviors.
The article cites three components:
- Body Scan – Gradually sweep your attention across your body from head to toe, paying uncritical attention to sensations or sensations, and using breath awareness and relaxation advice regularly.
- Focus on breathing or belly rising and non-judgmental awareness of thoughts and distractions.
- Breathing exercises, simple stretches and poses to strengthen and relax the musculoskeletal system.
Pioneers in the field include Jon Kabat-Zinn, who established mindfulness centers in healthcare and society University of Massachusetts Memorial Medical Center. Caroline McManusa physical therapist, established a Mindfulness Program at Swedish Health Center Seattle and offers courses on the subject. A concise summary of mindfulness on pain management written by McManus on the Swedish Health website states:
“Mindfulness means being aware of the moment, and it provides you with a constructive, practical and effective way to observe your physical, cognitive and emotional responses and make smart choices to reduce your pain and suffering. Remember , you may not be able to control your pain, but you do have control over your response to pain. Your choices directly affect your nervous system activity.”
Kaiser Permanente’s Mindfulness and Behavioral Health Digital Ecosystem
Before the pandemic, Kaiser Permanente developed the building blocks of a mindfulness-focused formulary. The needs are clear. A survey of health system members found that about 20 to 25 percent did not meet diagnostic criteria for clinical depression and related mental health problems, but were still seeking help. Health systems attempt to provide self-help tools that can be easily downloaded but also incorporate human-centred design principles.
In the initial stages of creating a digital health and wellness ecosystem in 2017, Kaiser Permanente surveyed 38 patients with mild to moderate depressive and anxiety symptoms and 61 frontline clinicians and staff. Based on insights gleaned from the survey, it created a multi-pronged health and wellness ecosystem in 2018. It includes a curated portfolio of recommended apps with evidence of clinical efficacy and user satisfaction. The health system then enables clinicians to refer patients to the app, record their referrals in an electronic health record, and easily send patients a secure text message with a link to download the app. Health systems also provide clinician training and support materials developed by their country teams in collaboration with frontline clinicians. Kaiser Permanente also uses the American Psychiatric Association’s app assessment model as a starting point Select an existing application for a pilot of the ecosystem. The ecosystem is also built on a framework that addresses privacy and security, patient engagement and interoperability.
After pilots in 2018 and 2019, the digital ecosystem went live in February 2020 when the pandemic began.
Kaiser Permanente’s digital formulary aggregates a set of six applications. They include mindfulness and meditation apps Calm and Rethink Nursing (formerly known as Whil) and the Cognitive Behavioural Therapy app my power, silver cloud and Flourish.
As of May 2020, Kaiser Permanente had trained 1,600 staff to use digital formularies and developed best practices for prescribing patients in countless settings, especially in primary care.Last year, its work on digital health and wellness ecosystems was Posted in NEJM Catalyst.
To date, about 60 percent of the 121,000 patients who have downloaded these apps after a doctor’s referral have used mindfulness apps.
Mindfulness-focused health apps play an important role in healthcare, Trina Histon, senior principal advisor for prevention, wellness and digital health at Kaiser Permanente, said in a phone interview.
“I think there’s a huge opportunity to connect the head with the body,” she said. “We know from all the published papers on the pandemic – that stress, anxiety and insomnia make life miserable for patients… Of course, the field is ripe for innovation, and a lot of people are doing things in digital health, such as Mindfulness applications.”
One benefit of these apps is that they can help patients who may be uncomfortable with a referring therapist or need an immediate solution to their anxiety and stress. Histon added that despite all the scary things the pandemic has brought, it has at least underscored the need for easily accessible mental health resources and led to more candid conversations about mental health.
“The silver lining of the pandemic is that people are more willing to talk about the struggles they’ve been going through,” Histon said. She also observed that, unlike other generations who feared being stigmatized for discussing their mental health needs, members of Gen Z were less afraid.
Looking to the future, Histon said she is currently working with the team Develop an ecosystem focused on the health of young people.
Digital Health Companies and Mindfulness
Anxiety and insomnia have driven people to use Headspace’s app, CEO Russ Glass said.
“Anxiety is one of the most common issues Headspace members address using the app; 36% of new members (with Headspace for less than a month) say their goal is to sleep better. ‘Reduce or manage stress’ is a new member choice ,” Glass shared, citing the December 2021 Headspace membership census. “When asked which meditation topics were most relevant to them, 62% of Headspace users said meditation on happiness, kindness, and patience was most relevant; 55% said meditation on dealing with difficult emotions was relevant, and 59% said meditation on Anxiety-centered meditation was most relevant.”
When asked about the role apps like Headspace can play in healthcare, Glass noted that they provide affordable and accessible meditation and mindfulness practices, offering a scalable way to start addressing current mental health issues crisis.
Going forward, Glass said that Headspace plans to continue building its content library by including more voices and more cultures and experiences representative of its members. Given the way Covid-19 is affecting people’s lives, the company has added content specifically to help manage grief, fear and uncertainty. It also plans to work on completing the Ginger integration.
While patients who mention health apps like Headspace and Ginger make up the majority of users who download them, overworked healthcare workers and clinicians are another important group of users. OmPractice works with self-insured employers as well as hospitals to provide users with mindfulness and yoga practices.
“We tend to attract companies that have to take on high-stress roles (such as employees at Beth Israel Lahey Healthcare), or partners/payers whose employees/members use their bodies during the work process to stand up all day,” OmPractice co-founder Ke Reese Lucas said. “One of our earliest clients was the Massachusetts Interstate Insurance Association (MIIA), which serves many municipal employees (DPWs, teachers, etc.) in our state. Since then, we have partnered with many other large health insurers who Hope to bring the known benefits of mindful movement and stillness to its members and employees.”
According to Lucas, “Back Care and Yoga for Neck Pain” classes are always a hit. In user feedback, 69% reported less stress after using the app, and 63% reported feeling happier overall.
OmPractice’s app is also available to veterans through a partnership with the Veterans Affairs Medical Center and the Veterans Integrated Services Network. Although OmPractice started out as a pilot in 2019, OmPractice’s work with veterans has since started. Lucas said more than 2 million veterans have access to its app.
“Our goal is to start updating the medical records that record class attendance so clinicians can get a complete picture of a patient’s health,” Lucas said. “Our goal next year is to fundamentally upgrade our data platform so that we can show users more granular progress that is often difficult to see or feel early on. This is the number one reason why people don’t stick to these practices, and we will change that.”
Mindfulness in Physical Therapy and Pain Management
According to McManus, mindfulness techniques are also great for physical therapy and chronic pain relief for several reasons.
“I think it’s very important to help patients feel at home in their own bodies. So many people start off with judgment and criticism about their bodies, and then they might get angry that their bodies are ‘disappointed,'” he said. “This conflicting relationship can further exacerbate stress and distress, which are barriers to well-being. Physical therapists can help patients learn to focus on their bodies with a mindful attitude of acceptance, kindness, and curiosity.”
McManus also noted that mindfulness is well suited for physical therapists’ approach to therapy because they understand that “the complex nature of pain is a complex perceptual process” that includes the interplay of sensory information, cognition, and emotion.
“To be successful, we appreciate the adoption of a biopsychosocial approach, particularly in chronic pain treatment. and emotional responses when addressing these multiple factors to pain. We can then instruct them to self-regulate their response to pain. “
Collaboration between health systems, payers and digital health companies is encouraging for patients and clinicians to manage stress, anxiety and chronic pain. Mindfulness could become an important part of improving the patient healthcare experience and addressing how we can prevent clinician burnout. While these examples provide valuable insights into how to address behavioral health needs, it will be interesting to see if mindfulness becomes an integral part of healthcare in the future.
Photo credit: DrAfter123, Getty Images
