Dataset Information

Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability.

ABSTRACT: In 2016, 21 million Americans aged 12 years and older needed treatment for a substance use disorder (SUD). However, only 10% to 11% of individuals requiring SUD treatment received it. Given their access to patients, primary care providers are in a unique position to perform universal Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify individuals at risk, fill gaps in services, and make referrals to specialty treatment when indicated. Major barriers to SBIRT include limited time among providers and low motivation to change among many patients.The objective of this study was to develop and test the acceptability of a prototype of a mobile-delivered substance use risk intervention (SURI) for primary care patients and a clinical dashboard for providers that can address major barriers to SBIRT for risky drug use. The SURI delivers screening and feedback on SUD risk via mobile tools to patients at home or in the waiting room; for patients at risk, it also delivers a brief intervention based on the transtheoretical model of behavior change (TTM) to facilitate progress through the stages of change for quitting the most problematic drug and for seeking treatment if indicated. The prototype also delivers 30 days of stage-matched text messages and 4 Web-based activities addressing key topics. For providers, the clinical dashboard summarizes the patient's SUD risk scores and stage of change data, and provides stage-matched scripts to guide in-person sessions.A total of 4 providers from 2 federally qualified health centers (FQHCs) were recruited for the pilot test, and they in turn recruited 5 patients with a known SUD. Furthermore, 3 providers delivered dashboard-guided SBIRT sessions and completed a brief acceptability survey. A total of 4 patients completed a Web-based SURI session and in-person SBIRT session, accessed other program components, and completed 3 acceptability surveys over 30 days. Questions in the surveys were adapted from the National Cancer Institute's Education Materials Review Form. Response options ranged from 1=strongly disagree to 5=strongly agree. The criterion for establishing acceptability was an overall rating of 4.0 or higher across items.For providers, the overall mean acceptability rating was 4.4 (standard deviation [SD] 0.4). Notably, all providers gave a rating of 5.0 for the item, "The program can give me helpful information about my patient." For patients, the overall mean acceptability rating was 4.5 (SD 0.3) for the mobile- and provider-delivered SBIRT sessions and 4.0 (SD 0.4) for the text messages and Web-based activities. One highly rated item was "The program could help me make some positive changes" (4.5).The SURI program and clinical dashboard, developed to reduce barriers to SBIRT in primary care, were well received by providers and patients.

SUBMITTER: Levesque D

PROVIDER: S-EPMC5770579 | biostudies-other | 2018 Jan

REPOSITORIES: biostudies-other

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Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability.

Levesque Deborah D Umanzor Cindy C de Aguiar Emma E

JMIR medical informatics 20180102 1

<h4>Background</h4>In 2016, 21 million Americans aged 12 years and older needed treatment for a substance use disorder (SUD). However, only 10% to 11% of individuals requiring SUD treatment received it. Given their access to patients, primary care providers are in a unique position to perform universal Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify individuals at risk, fill gaps in services, and make referrals to specialty treatment when indicated. Major barriers to ...[more]

PMID: 29295811

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Project description:BACKGROUND:Advances in experimental psychology have highlighted the need to modify underlying automatic cognitive biases, such as attentional biases. The effectiveness of bias modification has been well studied for substance use disorders. With recent advances in technology, it is now possible to work outside the laboratory with Web-based and mobile-based attention bias interventions. Gamification technologies might also help diminish the repetitiveness of the task and increase the intrinsic motivation to train. The inconsistent findings of the impact of gaming on the effectiveness of mobile interventions call for further work to better understand the needs of patients (users) and health care professionals. OBJECTIVE:The aim of this study was to involve patients, together with health care professionals, in the design of a gamified mobile attention bias modification intervention for substance use disorders. METHODS:The participatory design research method adopted is that of a user-oriented design approach in the form of a future workshop. In the first phase of the workshop, participants shared their critique of an attention bias modification intervention. In the second phase of the workshop, participants were asked to brainstorm features. Participants were also shown gamification approaches and asked to consider if gaming elements could enhance the existing app. In the last phase, participants were asked to sketch a new prototype. RESULTS:Three co-design workshops were conducted with health care professionals, inpatients, and outpatients. There were 20 participants, consisting of 10 health care professionals and 10 patients. When asked to identify the limitations in the existing app, common issues identified were those of the design, visual probe task, and the included images. Outpatients were also concerned with the safety of administration of the intervention. In the brainstorming sessions, health care professionals made recommendations as to how the stimulus, the mechanism of responding, and the presentation of the scores could be enhanced. Inpatient participants recommended the addition of functionalities, such as information on the harms associated with the substance use, and for there to be enhancements in the design, images, and task. Outpatient participants perceived a need to improve the images and presentation of the results and recommended the inclusion of gaming features. There were differences in opinion on the inclusion of gaming features, as only health care professionals endorsed their inclusion. In the last phase of the workshop, participants were tasked with the conceptualization of prototypes, and the commonality in the design was for a gradual shortening of the interval for stimulus/image presentation. CONCLUSIONS:The results from this research will guide the development of an app that meets the specific needs of patients and is still based on a pre-existing validated task paradigm. .

Project description:While there is broad recognition of the high societal costs of substance use disorders (SUD), treatment rates are low. We examined whether, in the United States, participants with substance or alcohol use disorder would report a greater willingness to enter SUD treatment located in a primary care setting (primary care) or more commonly found specialty care setting in the United States (usual care).Randomized survey-embedded experiment.US web-based research panel in which participants were randomized to read one-paragraph vignettes describing treatment in usual care (specialty drug or alcohol treatment center), primary care or collaborative care within a primary care setting.A total of 42 451 panelists aged 18+ were screened for substance or alcohol use disorder using validated diagnostic criteria. Participants included 344 with a substance use disorder and 634 with an alcohol use disorder not in treatment with no prior treatment history.Willingness to enter treatment across vignettes by condition.Among participants with a substance use disorder, 24.6% of those randomized to usual care reported being willing to enter drug treatment compared with 37.2% for primary care [12.6 percentage point difference; 95% confidence interval (CI) = 0.8, 24.4) and 34.0% for collaborative care (9.4 percentage point difference; 95% CI = -2.0, 20.8). Among participants with an alcohol use disorder, 17.6% of those randomized to usual care reported being willing to enter alcohol treatment compared with 20.3% for primary care (2.6 percentage point difference; 95% CI = -4.9, 10.1) and 20.8% for collaborative care (3.1 percentage point difference; 95% CI = -4.3, 10.6). The most common reason for not being willing to enter drug (63%) and alcohol (78%) treatment was the belief that treatment was not needed.In the United States, people diagnosed with substance or alcohol use disorders appear to be more willing to enter treatment in a primary care setting than in a specialty drug treatment center. Expanding availability of primary care-based substance use disorder treatment could increase treatment rates in the United States.

Project description:BackgroundMillions of people who need treatment for substance use disorders (SUD) do not receive it. Evidence-based practices for treating SUD exist, and some are appropriate for delivery outside of specialty care settings. Primary care is an opportune setting in which to deliver SUD treatment because many individuals see their primary care providers at least once a year. Further, the Patient Protection and Affordable Care Act (PPACA) increases coverage for SUD treatment and is increasing the number of individuals seeking primary care services. In this article, we present the protocol for a study testing the effects of an organizational readiness and service delivery intervention on increasing the uptake of SUD treatment in primary care and on patient outcomes.Methods/designIn a randomized controlled trial, we test the combined effects of an organizational readiness intervention consisting of implementation tools and activities and an integrated collaborative care service delivery intervention based on the Chronic Care Model on service system (patient-centered care, utilization of substance use disorder treatment, utilization of health care services and adoption and sustainability of evidence-based practices) and patient (substance use, consequences of use, health and mental health, and satisfaction with care) outcomes. We also use a repeated measures design to test organizational changes throughout the study, such as acceptability, appropriateness and feasibility of the practices to providers, and provider intention to adopt the practices. We use provider focus groups, provider and patient surveys, and administrative data to measure outcomes.DiscussionThe present study responds to critical gaps in health care services for people with substance use disorders, including the need for greater access to SUD treatment and greater uptake of evidence-based practices in primary care. We designed a multi-level study that combines implementation tools to increase organizational readiness to adopt and sustain evidence-based practices (EBPs) and tests the effectiveness of a service delivery intervention on service system and patient outcomes related to SUD services.Trial registrationCurrent controlled trials: NCT01810159.

Dataset Information

Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability.

Publications

Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability.

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