Delivering Remote Measurement-Based Care in Community Addiction Treatment: Engagement and Usability Over a 6-Month Clinical Pilot

Kevin A Hallgren, Eliza B Cohn, Richard K Ries, David C Atkins, Kevin A Hallgren, Eliza B Cohn, Richard K Ries, David C Atkins

Abstract

Objective: Measurement-based care (MBC) is an evidence-based practice in which patients routinely complete standardized measures throughout treatment to help monitor clinical progress and inform clinical decision-making. Despite its potential benefits, MBC is rarely used in community-based substance use disorder (SUD) treatment. In this pilot study, we evaluated the feasibility of incorporating a digital and remotely delivered MBC system into SUD treatment within a community setting by characterizing patients' and clinicians' engagement with and usability ratings toward the MBC system that was piloted.

Methods: A pilot study was conducted with 30 patients receiving SUD treatment and eight clinicians providing SUD treatment in a large, publicly funded addiction and mental health treatment clinic. Services as usual within the clinic included individual psychotherapy, case management, group therapy, peer support, and medication management for mental health and SUD, including buprenorphine. Patients who enrolled in the pilot continued to receive services as usual and were automatically sent links to complete a 22-item questionnaire, called the weekly check-in, via text message or email weekly for 24 weeks. Results of the weekly check-in were summarized on a clinician-facing web-based dashboard. Engagement was characterized by calculating the mean number of weekly check-ins completed by patients and the mean number times clinicians logged into the MBC system. Ratings of the MBC system's usability and clinical utility were provided by patients and clinicians.

Results: Patient participants (53.3% male, 56.7% white, 90% Medicaid enrolled) completed a mean of 20.60 weekly check-ins (i.e., 85.8% of the 24 expected per patient). All but one participating clinician with a patient enrolled in the study logged into the clinician-facing dashboard at least once, with an average of 12.20 logins per clinician. Patient and clinician ratings of usability and clinical utility were favorable: most patients agreed with statements that the weekly check-in was easy to navigate and aided self-reflection. All clinicians who completed usability questionnaires agreed with statements indicating that the dashboard was easy to navigate and that it provided meaningful information for SUD treatment.

Conclusions: A digital and remotely delivered MBC system can yield high rates of patient and clinician engagement and high ratings of usability and clinical utility when added into SUD treatment as usual. The success of this clinical pilot may be attributable, in part, to the user-centered design processes that were used to develop and refine the MBC system that was piloted. Future efforts may focus on strategies to test whether MBC can be sustainably implemented and offers clinical benefits to patients in community SUD treatment settings.

Keywords: addiction; measurement-based care (MBC); recovery; routine outcome monitoring (ROM); user-centered design (UCD).

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Hallgren, Cohn, Ries and Atkins.

Figures

FIGURE 1
FIGURE 1
Study timeline.
FIGURE 2
FIGURE 2
Screenshots showing selected sections of the weekly check-in completed by patients, including questions about substance use (A), mechanisms of change (B), next-week goals (C), and optional open-ended/free-text questions (D).
FIGURE 3
FIGURE 3
Screenshots showing selected sections of the clinician dashboard, including sections that display line graphs of patient progress over time (A), text-based information about patient progress over time (B), responses to the most recently completed weekly check-in (C), and a table with all responses weekly check-ins previously completed (D).
FIGURE 4
FIGURE 4
Number (left axis) and percentage (right axis) of patients completing a weekly check-in during each week of the clinical pilot. The shaded region reflects the 95% CI of the estimated percentage for each week.

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