scholarly journals Approaches for Implementing App-Based Digital Treatments for Drug Use Disorders Into Primary Care: A Qualitative, User-Centered Design Study of Patient Perspectives

10.2196/25866 ◽  
2021 ◽  
Vol 23 (7) ◽  
pp. e25866
Author(s):  
Joseph E Glass ◽  
Theresa E Matson ◽  
Catherine Lim ◽  
Andrea L Hartzler ◽  
Kilian Kimbel ◽  
...  
Keyword(s):  
Primary Care ◽  
Drug Use ◽  
Opioid Use Disorder ◽  
User Centered Design ◽  
Opioid Use ◽  
Kaiser Permanente ◽  
Secure Messaging ◽  
Phone Calls ◽  
Drug Use Disorders ◽  
User Centered

Background Digital interventions, such as websites and smartphone apps, can be effective in treating drug use disorders (DUDs). However, their implementation in primary care is hindered, in part, by a lack of knowledge on how patients might like these treatments delivered to them. Objective This study aims to increase the understanding of how patients with DUDs prefer to receive app-based treatments to inform the implementation of these treatments in primary care. Methods The methods of user-centered design were combined with qualitative research methods to inform the design of workflows for offering app-based treatments in primary care. Adult patients (n=14) with past-year cannabis, stimulant, or opioid use disorder from 5 primary care clinics of Kaiser Permanente Washington in the Seattle area participated in this study. Semistructured interviews were recorded, transcribed, and analyzed using qualitative template analysis. The coding scheme included deductive codes based on interview topics, which primarily focused on workflow design. Inductive codes emerged from the data. Results Participants wanted to learn about apps during visits where drug use was discussed and felt that app-related conversations should be incorporated into the existing care whenever possible, as opposed to creating new health care visits to facilitate the use of the app. Nearly all participants preferred receiving clinician support for using apps over using them without support. They desired a trusting, supportive relationship with a clinician who could guide them as they used the app. Participants wanted follow-up support via phone calls or secure messaging because these modes of communication were perceived as a convenient and low burden (eg, no copays or appointment travel). Conclusions A user-centered implementation of treatment apps for DUDs in primary care will require health systems to design workflows that account for patients’ needs for structure, support in and outside of visits, and desire for convenience.

scholarly journals Approaches for Implementing App-Based Digital Treatments for Drug Use Disorders Into Primary Care: A Qualitative, User-Centered Design Study of Patient Perspectives (Preprint)

2020 ◽  
Author(s):  
Joseph E Glass ◽  
Theresa E Matson ◽  
Catherine Lim ◽  
Andrea L Hartzler ◽  
Kilian Kimbel ◽  
...  
Keyword(s):  
Primary Care ◽  
Drug Use ◽  
Opioid Use Disorder ◽  
User Centered Design ◽  
Opioid Use ◽  
Kaiser Permanente ◽  
Secure Messaging ◽  
Phone Calls ◽  
Drug Use Disorders ◽  
User Centered

BACKGROUND Digital interventions, such as websites and smartphone apps, can be effective in treating drug use disorders (DUDs). However, their implementation in primary care is hindered, in part, by a lack of knowledge on how patients might like these treatments delivered to them. OBJECTIVE This study aims to increase the understanding of how patients with DUDs prefer to receive app-based treatments to inform the implementation of these treatments in primary care. METHODS The methods of user-centered design were combined with qualitative research methods to inform the design of workflows for offering app-based treatments in primary care. Adult patients (n=14) with past-year cannabis, stimulant, or opioid use disorder from 5 primary care clinics of Kaiser Permanente Washington in the Seattle area participated in this study. Semistructured interviews were recorded, transcribed, and analyzed using qualitative template analysis. The coding scheme included deductive codes based on interview topics, which primarily focused on workflow design. Inductive codes emerged from the data. RESULTS Participants wanted to learn about apps during visits where drug use was discussed and felt that app-related conversations should be incorporated into the existing care whenever possible, as opposed to creating new health care visits to facilitate the use of the app. Nearly all participants preferred receiving clinician support for using apps over using them without support. They desired a trusting, supportive relationship with a clinician who could guide them as they used the app. Participants wanted follow-up support via phone calls or secure messaging because these modes of communication were perceived as a convenient and low burden (eg, no copays or appointment travel). CONCLUSIONS A user-centered implementation of treatment apps for DUDs in primary care will require health systems to design workflows that account for patients’ needs for structure, support in and outside of visits, and desire for convenience.

scholarly journals Computerized Clinical Decision Support System for Emergency Department–Initiated Buprenorphine for Opioid Use Disorder: User-Centered Design (Preprint)

2018 ◽  
Author(s):  
Jessica M Ray ◽  
Osama M Ahmed ◽  
Yauheni Solad ◽  
Matthew Maleska ◽  
Shara Martel ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Emergency Care ◽  
Clinical Decision ◽  
Opioid Use Disorder ◽  
Care Pathways ◽  
User Centered Design ◽  
Opioid Use ◽  
Prototype Development ◽  
User Centered

BACKGROUND Emergency departments (EDs) frequently care for individuals with opioid use disorder (OUD). Buprenorphine (BUP) is an effective treatment option for patients with OUD that can safely be initiated in the ED. At present, BUP is rarely initiated as a part of routine ED care. Clinical decision support (CDS) could accelerate adoption of ED-initiated BUP into routine emergency care. OBJECTIVE This study aimed to design and formatively evaluate a user-centered decision support tool for ED initiation of BUP for patients with OUD. METHODS User-centered design with iterative prototype development was used. Initial observations and interviews identified workflows and information needs. The design team and key stakeholders reviewed prototype designs to ensure accuracy. A total of 5 prototypes were evaluated and iteratively refined based on input from 26 attending and resident physicians. RESULTS Early feedback identified concerns with the initial CDS design: an alert with several screens. The timing of the alert led to quick dismissal without using the tool. User feedback on subsequent iterations informed the development of a flexible tool to support clinicians with varied levels of experience with the intervention by providing both one-click options for direct activation of care pathways and user-activated support for critical decision points. The final design resolved challenging navigation issues through targeted placement, color, and design of the decision support modules and care pathways. In final testing, users expressed that the tool could be easily learned without training and was reasonable for use during routine emergency care. CONCLUSIONS A user-centered design process helped designers to better understand users’ needs for a Web-based clinical decision tool to support ED initiation of BUP for OUD. The process identified varying needs across user experience and familiarity with the protocol, leading to a flexible design supporting both direct care pathways and user-initiated decision support.

scholarly journals 3543 Translating the complex medical jargon of opioid use disorder and medication assisted treatment into locally relevant messages in rural Colorado using Boot Camp Translation

2019 ◽  
Vol 3 (s1) ◽  
pp. 97-98
Author(s):  
Mary Fisher ◽  
Donald E. Nease ◽  
Linda Zittleman ◽  
Jack Westfall ◽  
Jennifer Ancona
Keyword(s):  
Primary Care ◽  
Local Community ◽  
Boot Camp ◽  
Opioid Use Disorder ◽  
Research Network ◽  
High Plains ◽  
Opioid Use ◽  
Community Members ◽  
Medication Assisted Treatment ◽  
South Central

OBJECTIVES/SPECIFIC AIMS: Opioid use disorder (OUD) is a national epidemic and identified as a top priority by the practices and communities in rural Colorado. Until recently, few resources existed to address OUD in rural communities. In addition to training primary care and behavioral health practice teams in medication assisted treatment (MAT), Implementing Technology and Medication Assisted Treatment and Team Training and in Rural Colorado (IT MATTTRs Colorado) engaged local community members to alter the community conversation around OUD and treatment. For IT MATTTRs, the High Plains Research Network and the Colorado Research Network engaged community members in a 8-10 month process known as Boot Camp Translations (BCT) to translate medical information and jargon around OUD and MAT into concepts, messages, and materials that are meaningful and actionable to community members. The resulting community interventions are reported here. METHODS/STUDY POPULATION: IT MATTTRs conducted separate BCTs in Eastern Colorado and the south central San Luis Valley. Community partners included non-health professionals with diverse backgrounds, public health and primary care professionals, law enforcement, and others. The BCT process includes a comprehensive education on OUD and MAT and facilitated meetings and calls to develop messages and dissemination strategies. Each BCT lasted around 8-10 months. RESULTS/ANTICIPATED RESULTS: The BCT process elicited unique contextual ideas and constructs for messages, materials, and dissemination strategies. Themes common to both BCTs include the prevalence of OUD and that help is available in the local primary care office. Community-tailored messages are distributed through posters and flyer inserts, drink coasters, newspaper articles, letters to local judges, restaurant placemats, and websites. Examples of the materials and messages will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: Local community members are eager to help address the OUD crisis. Built on community-based participatory research principles, BCT can be used to translate complex information and guidelines around OUD and MAT into messages and materials that reflect local culture and community needs.

Primary Care of Opioid use Disorder: The End of “the French Model”?

2020 ◽  
Vol 26 (6) ◽  
pp. 346-354 ◽  
Author(s):  
Julie Dupouy ◽  
Sandy Maumus-Robert ◽  
Yohann Mansiaux ◽  
Antoine Pariente ◽  
Maryse Lapeyre-Mestre
Keyword(s):  
Primary Care ◽  
Private Practice ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
Access To Treatment ◽  
Cross Sectional ◽  
Number Of Patients ◽  
French Model

<b><i>Background:</i></b> In France, most patients with opioid use disorder (OUD) have been treated by buprenorphine, prescribed by general practitioners (GP) in private practice since 1996. This has contributed to building a ‘French model’ facilitating access to treatment based on the involvement of GPs in buprenorphine prescription. <b><i>Objectives:</i></b> Our study aimed to assess whether the involvement of primary care in OUD management has changed lately. <b><i>Materials and Methods:</i></b> Using data from the French National Health Insurance database, we conducted a yearly repeated cross-sectional study (2009–2015) and described proportion of opioid maintenance treatment (OMT)-prescribing GPs and OMT-dispensing community pharmacies (CP); and number of patients by GP or CP. <b><i>Results:</i></b> Whereas the number of buprenorphine-prescribing GPs in private practice remained quite stable (decrease of 3%), a substantial decrease in buprenorphine initial prescribers among private GPs was observed. In 2009, 10.3% of private GPs (6,297 from 61,301 French private GPs) prescribed buprenorphine for the initiation of a treatment, whereas they were 5.7% (<i>n</i> = 3,539 from 62,071 private GPs) in 2015 (43.8% decrease). GPs issuing initial prescriptions of buprenorphine tended to care for a higher number of patients treated by buprenorphine (14.6 ± 27.1 patients in 2009 to 16.0 ± 35.4 patients in 2015). The number of CPs dispensing buprenorphine remained quite stable (decrease of 2%), while there was a 7.5% decrease in the total number of French CPs across the study period. <b><i>Conclusions:</i></b> Our results suggest that primary care providers seem less engaged in buprenorphine initiation in OUD patients, while CPs have not modified their involvement towards these patients.

Why use group visits for opioid use disorder treatment in primary care? A patient-centered qualitative study

2017 ◽  
Vol 39 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Randi Sokol ◽  
Chiara Albanese ◽  
Deviney Chaponis ◽  
Jessica Early ◽  
George Maxted ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Patient Centered ◽  
Group Visits ◽  
Disorder Treatment

scholarly journals Project ECHO and primary care buprenorphine treatment for opioid use disorder: Implementation and clinical outcomes

2021 ◽  
pp. 1-9
Author(s):  
James B. Anderson ◽  
Stephen A. Martin ◽  
Anne Gadomski ◽  
Nicole Krupa ◽  
Daniel Mullin ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Outcomes ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Project Echo ◽  
Buprenorphine Treatment

Abstract 228: National Prevalence of Substance Use Disorders Among Hospitalized Heart Failure Patients

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Sarah C Snow ◽  
Gregg C Fonarow ◽  
Joseph A Ladapo ◽  
Donna L Washington ◽  
Katherine Hoggatt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Substance Use ◽  
Native American ◽  
Drug Use ◽  
Substance Use Disorders ◽  
Age Groups ◽  
Opioid Use ◽  
Drug Use Disorders ◽  
Increased Risk ◽  
Drug Use Disorder

Background: Several cardiotoxic substances contribute to the development of heart failure (HF). The burden of comorbid substance use disorders (SUD) among patients with HF is under-characterized. Objectives: To describe the national burden of comorbid SUD (tobacco, alcohol, or drug use disorders) among hospitalized HF patients in the U.S. Methods: We used data from the 2014 National Inpatient Sample to calculate the proportion of hospitalizations for a primary HF admission with tobacco, alcohol, or drug use disorder diagnoses, accounting for demographic factors. Drug use disorder analysis was further sub-divided into specific illicit substance categories. Results: There were a total of 989,080 HF hospitalizations of which 35.3% (n=348,995) had a documented SUD. Tobacco use disorder (TUD) was most common (n= 327,220, 33.1%) followed by drug use disorder (DUD) (n=34,600, 3.5%) and alcohol use disorder (AUD) (n=34,285, 3.5%). Female sex was associated with less TUD (OR 0.59; 95% CI, 0.58-0.60), AUD (OR 0.23; 95% CI, 0.22-0.25) or DUD (OR 0.58; 95% CI 0.55-0.62). Tobacco, alcohol, cocaine, and opioid use disorders were highest among HF patients age 45 to 55, while cannabis and amphetamine use was highest in those <45 years. Native American race (versus White) was associated with increased risk of AUD (OR 1.67; 95% CI 1.27-2.20). Black race was associated with increased risk of AUD (OR 1.09; 95% CI 1.02-1.16) or DUD (OR 1.63; 95% CI 1.53-1.74). Medicaid insurance (versus Medicare) was associated with greater TUD (OR 1.27; 95% CI 1.23-1.32), AUD (OR 1.74; 95% CI 1.62-1.87), and DUD (OR 2.15; 95% CI 2.01-2.30). Decreasing quartiles of median household income were associated with increasing SUD. Conclusions: Comorbid SUD disproportionately affects certain HF populations, including men, younger age groups, lower SES patients, and race/ethnic minorities. Further research on interventions to improve prevention and treatment of SUD among hospitalized HF patients are needed given the high rates of SUD in this population. Systematically screening hospitalized HF patients for SUD may reveal opportunities for treatment and secondary prevention.

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