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Davidson RM, Brown HD, Regnier SD, DeFulio A. Incentivized collaborative care to disseminate and enhance contingency-management services. J Appl Behav Anal 2024. [PMID: 39004776 DOI: 10.1002/jaba.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/06/2024] [Indexed: 07/16/2024]
Abstract
Contingency management is especially effective in supporting medication adherence and drug abstinence among people with opioid use disorder. However, the incorporation of contingency management into clinical practice has been slow. The present study was designed to evaluate the feasibility, acceptability, and usability of incentives for providers as a means of accelerating collaborative care with contingency management. Thirteen buprenorphine prescribers served as participants in a nonexperimental study. The prescribers who referred patients to a contingency-management service received monetary incentives for reviewing patient performance data and describing their use of these data in treatment decisions. The results show that this approach is feasible, acceptable, and easy to use for everyone involved. Self-reports indicate improved prescriber-patient relationships and more informed care. However, prescriber-focused incentives did not appear to greatly enhance access to contingency-management services for patients. Thus, provider incentives may be beneficial but further research is needed to advance adoption of contingency management.
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Affiliation(s)
| | - Hayley D Brown
- Department of Psychology, Western Michigan University, Kalamazoo, MI, USA
| | - Sean D Regnier
- Department of Psychology, Western Michigan University, Kalamazoo, MI, USA
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Anthony DeFulio
- Department of Psychology, Western Michigan University, Kalamazoo, MI, USA
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Rollston R, Burke B, Weiner SG, Gallogly W, Brandon AD, Carter R, Clear B. Evaluation of urine drug screen falsification of results among patients with opioid use disorder receiving treatment in a telehealth model of care. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 154:209151. [PMID: 37652209 DOI: 10.1016/j.josat.2023.209151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/22/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION As telehealth models for treatment of opioid use disorder (OUD) are expanding, the field does not know the reliability of urine drug screening (UDS) in this setting. The objective of this study is to determine the rate of falsification of UDS testing among patients with OUD in active treatment with buprenorphine via a telehealth provider. METHODS This is a prospective cohort study of 899 randomly selected eligible patients, of which 392 participated in the final cohort that the study team used for analysis. The study mailed patients a UDS cup and asked them to return the sample by mail. After the UDS sample was received, a buccal swab was mailed, and the study asked patients to schedule a virtual meeting in which consent was sought and an observed buccal swab was obtained. We evaluated urine for evidence of falsification, and used buccal swabs to genetically match individuals to urine samples. RESULTS After exclusion criteria, 395 (52.3 %) of 755 patients who received a UDS kit returned it for analysis prior to knowledge of the study. Of that, 392 samples had sufficient quantity for testing. We determined 383 (97.7 %) to be human urine containing buprenorphine without indication of exogenous buprenorphine addition and with evidence of compliance. A total of 374 patients received a buccal swab kit and 139 (37.2 %) attended the consent/observed buccal swab session. One hundred and thirty-two patients consented and completed the swab under video observation, and 120 successfully sent the swab back to the external laboratory. Of the 120 buccal swabs received, 109 (90.8 %) were a genetic match, 10 (8.3 %) were indeterminate, and 1 (0.8 %) was a genetic mismatch. CONCLUSIONS This study of patients treated by a telehealth OUD provider demonstrated a low rate of urine test falsification.
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Affiliation(s)
| | - Barbara Burke
- Bicycle Health, Inc., Boston, MA, United States of America
| | - Scott G Weiner
- Bicycle Health, Inc., Boston, MA, United States of America; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States of America.
| | | | | | - Robyn Carter
- Bicycle Health, Inc., Boston, MA, United States of America
| | - Brian Clear
- Bicycle Health, Inc., Boston, MA, United States of America
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Kratina-Hathaway Z, Radick AC, Leroux BG, Blalock K, Kim TW, Darnton J, Saxon AJ, Samet JH, Tsui JI. Methamphetamine use and illicit opioid use during buprenorphine treatment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 151:208934. [PMID: 37811395 PMCID: PMC10554569 DOI: 10.1016/j.josat.2022.208934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Introduction Although methamphetamine use is rising in the United States, its impacts on patient outcomes among persons undergoing treatment for opioid use disorder (OUD) remain unclear. This study aims to assess the association between baseline methamphetamine/amphetamine (MA/A) use and subsequent illicit opioid use among patients with OUD initiating buprenorphine in an office-based setting. Methods We conducted a secondary analysis of a pilot randomized controlled trial of a behavioral mobile health intervention for buprenorphine adherence conducted over a 12-week study period at two clinic sites. The study defined baseline MA/A use by a positive urine drug test (UDT) and/or self-report of use within the past 30-days. Separate Poisson regression models with robust standard errors evaluated associations between MA/A and: i) illicit opioid use measured by weekly UDT (primary) and ii) self-reported past 30-day use at end of study (secondary). Other secondary outcomes included buprenorphine positive UDTs throughout the study and retention in OUD treatment at both weeks 12 and 24 post-randomization. Results At baseline, 28 (36%) of the 78 participants had MA/A use and use was associated with a statistically significant increase in risk of testing positive for illicit opioids on UDT during the study follow-up period (adjusted relative risk (aRR)=1.54; 95% CI=1.09-2.17; p=0.015), as well as an increased risk for reported past 30-day illicit opioid use at week 12 (aRR=3.86; 95% CI=1.47-10.18; P=0.006). The study found no significant associations between MA/A use and buprenorphine positive UDT or retention in OUD treatment. Conclusions In this sample of patients initiating buprenorphine, methamphetamine/amphetamine use at baseline was associated with illicit opioid use over a 12-week period. These findings demonstrate how co-use of methamphetamine can impede attainment of ideal OUD treatment outcomes.
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Affiliation(s)
- Zoë Kratina-Hathaway
- University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195
| | - Andrea C. Radick
- Division of General Internal Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Patricia Steel Building, 401 Broadway, Seattle, WA 98104
| | - Brian G. Leroux
- Department of Biostatistics, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195
| | - Kendra Blalock
- Comagine Health, 10700 Meridian Ave N #100, Seattle, WA 98133
| | - Theresa W. Kim
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 1st Floor, Boston, MA 02118
| | - James Darnton
- Division of General Internal Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Patricia Steel Building, 401 Broadway, Seattle, WA 98104
| | - Andrew J. Saxon
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S. Columbian Way (MC: S-116-ATC), Seattle, WA 98108
| | - Jeffrey H. Samet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 1st Floor, Boston, MA 02118
| | - Judith I. Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Patricia Steel Building, 401 Broadway, Seattle, WA 98104
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Bhatraju EP, Radick AC, Leroux BG, Kim TW, Samet JH, Tsui JI. Buprenorphine adherence and illicit opioid use among patients in treatment for opioid use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:511-518. [PMID: 37369019 DOI: 10.1080/00952990.2023.2220876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/23/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023]
Abstract
Background: Buprenorphine is a partial mu opioid agonist medication that has been shown to decrease non-prescribed opioid use, cravings, and opioid related morbidity and mortality. There is an assumption that full adherence is needed to achieve ideal treatment outcomes, and that non-adherence is associated with ongoing opioid use. However, literature documenting the strength of that assertion is lacking.Objectives: Evaluate the association between daily buprenorphine adherence and illicit opioid use.Methods: Secondary analysis of a 12-week randomized controlled trial of adults with opioid use disorder who recently initiated buprenorphine. Weekly study visits included self-report of daily buprenorphine adherence over the past 7 days (Timeline Follow Back method) and urine drug tests (UDT). A log-linear regression model accounting for clustering by participant was used to assess the association between buprenorphine adherence and illicit opioid use. Buprenorphine adherence was measured as a continuous variable (0-7 days).Results: Among 78 participants (56 men, 20 women, 2 nonbinary) with 737 visits, full 7-day adherence was reported at 70% of visits. The predominant form of non-adherence was missed doses (92% of cases). Each additional day of adherence was associated with an 8% higher rate of negative UDT for illicit opioids (RR = 1.08; 95% CI:1.03-1.13, p = .0002).Conclusion: In this sample of participants starting buprenorphine, missed doses were not uncommon. Fewer missed days was significantly associated with a lower risk of illicit opioid use. These findings suggest that efforts to minimize the number of missed days of buprenorphine are beneficial for treatment outcomes.
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Affiliation(s)
- Elenore P Bhatraju
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Andrea C Radick
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Brian G Leroux
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Theresa W Kim
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center Boston, Boston, MA, USA
| | - Jeffrey H Samet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center Boston, Boston, MA, USA
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
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DeFulio A, Brown HD, Davidson RM, Regnier SD, Kang N, Ehart M. Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone-Based Contingency Management Intervention for Buprenorphine Adherence. Behav Anal Pract 2023; 16:450-458. [PMID: 37187840 PMCID: PMC10170006 DOI: 10.1007/s40617-022-00730-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 10/17/2022] Open
Abstract
Buprenorphine is an important medication for treating opioid use disorder, but medication adherence and treatment retention are key issues that can limit its impact, especially when patients have concurrent stimulant use. Contingency management is efficacious in promoting medication adherence and drug abstinence. Delivering contingency management via smartphones addresses practical barriers to its adoption and improves patient access. A single-group (n = 20) nonexperimental study was conducted to evaluate the feasibility of smartphone-based contingency management to promote adherence to buprenorphine treatment in people with opioid use disorder. Participants were recruited from outpatient treatment clinics. Over 12 weeks participants had access to a smartphone app that provided contingency management supported with peer recovery coaching. Adherence was confirmed daily either by GPS monitoring of clinic medication visits or self-recorded video, and salivary toxicology was conducted weekly. The overall rate of confirmed buprenorphine adherence was 76%, and visual inspection of individual participant outcomes shows consistent medication use for a large majority of participants. All participants were able to successfully use all app features and spend earnings. Participants rated the app and intervention highly on measures of likability, ease of use, and helpfulness. All participants (100%) were retained in buprenorphine treatment throughout the study period. Direct methods for confirming adherence appear superior to confirmation via salivary toxicology. This study shows that smartphone-based contingency management is a feasible means of promoting buprenorphine adherence. The potential efficacy of smartphone-based contingency management as a means of promoting buprenorphine adherence warrants evaluation in a randomized controlled trial.
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Affiliation(s)
- Anthony DeFulio
- Department of Psychology, Western Michigan University, 1903 West Michigan Avenue, Mail Stop 5439, Kalamazoo, MI 49008 USA
| | - Hayley D. Brown
- Department of Psychology, Western Michigan University, 1903 West Michigan Avenue, Mail Stop 5439, Kalamazoo, MI 49008 USA
| | - Rosemarie M. Davidson
- Department of Psychology, Western Michigan University, 1903 West Michigan Avenue, Mail Stop 5439, Kalamazoo, MI 49008 USA
| | - Sean D. Regnier
- Department of Psychology, Western Michigan University, 1903 West Michigan Avenue, Mail Stop 5439, Kalamazoo, MI 49008 USA
- Present Address: College of Medicine, University of Kentucky, Lexington, KY USA
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Radick AC, James J, Leroux BG, Kim TW, Saxon AJ, Samet JH, Tsui JI. Use of Video Directly Observed Therapy and Characteristics Associated With Use Among Patients Treated With Buprenorphine in an Office-based Setting. J Addict Med 2023; 17:300-304. [PMID: 37267172 PMCID: PMC10123169 DOI: 10.1097/adm.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Video directly observed therapy (video DOT) is a tool for confirming buprenorphine adherence that could complement the use of urine toxicology; research is needed to characterize the patients who are receptive and able to use this technology. We aimed to describe video DOT utilization and assess participant characteristics associated with use. METHODS We performed a secondary analysis of data from a pilot randomized controlled trial of adults who recently initiated sublingual buprenorphine in office-based programs, restricting to intervention arm participants, which consisted of 12 weeks of video DOT via a mobile health technology platform. Participants were instructed to record at least 1 daily video of buprenorphine self-administration. Poisson regression models with robust standard errors were used to measure associations between participant characteristics and frequency of submitted videos. RESULTS The sample included 39 participants. Of 3276 possible videos, 1002 (31%) were submitted. Age ≥40 years (relative risk [RR], 2.54 [95% confidence interval {CI}, 1.31-4.91]) and once-daily buprenorphine dosing (RR, 3.10 [95% CI, 1.76-5.48]) were positively associated with video submissions. Non-White race (RR, 0.43 [95% CI, 0.19-0.97]), less than high school education (RR, 0.27 [95% CI, 0.10-0.74]), history of previous buprenorphine treatment (RR, 0.50 [95% CI, 0.25-0.97]), and ≥3 previous treatment attempts (RR, 0.16 [95% CI, 0.07-0.37]) were negatively associated. CONCLUSIONS Video DOT utilization resulted in about a third of expected videos, although there were differences in use according to age, race, buprenorphine treatment factors, and educational status. Such differences underscore that mobile-health interventions such as video DOT may not be equally used by all patients.Trial Registration : ClinicalTrails.gov , NCT03779997 , registered on December 19, 2018.
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Affiliation(s)
- Andrea C Radick
- From the Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA (ACR, JJ, JIT); Department of Biostatistics, University of Washington, Seattle WA (BGL); Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA (TWK, JHS); and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA (AJS)
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Darnton JB, Bhatraju EP, Beima-Sofie K, Michaels A, Hallgren KA, Soth S, Grekin P, Woolworth S, Tsui JI. "Sign Me Up": a qualitative study of video observed therapy (VOT) for patients receiving expedited methadone take-homes during the COVID-19 pandemic. Addict Sci Clin Pract 2023; 18:21. [PMID: 36991506 PMCID: PMC10052285 DOI: 10.1186/s13722-023-00372-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Federal and state regulations require frequent direct observation of methadone ingestion at an Opioid Treatment Program (OTP)-a requirement that creates barriers to patient access. Video observed therapy (VOT) may help to address public health and safety concerns of providing take-home medications while simultaneously reducing barriers to treatment access and long-term retention. Evaluating user experiences with VOT is important for understanding the acceptability of this strategy. METHODS We conducted a qualitative evaluation of a clinical pilot program of VOT via smartphone that was rapidly implemented between April and August 2020 during the COVID-19 pandemic within three opioid treatment programs. In the program, selected patients submitted video recordings of themselves ingesting methadone take-home doses, which were asynchronously reviewed by their counselor. We recruited participating patients and counselors for semi-structured, individual interviews to explore their VOT experiences after program completion. Interviews were audio recorded and transcribed. Transcripts were analyzed using thematic analysis to identify key factors influencing acceptability and the effect of VOT on the treatment experience. RESULTS We interviewed 12 of the 60 patients who participated in the clinical pilot and 3 of the 5 counselors. Overall, patients were enthusiastic about VOT, noting multiple benefits over traditional treatment experiences, including avoiding frequent travel to the clinic. Some noted how this allowed them to better meet recovery goals by avoiding a potentially triggering environment. Most appreciated having increased time to devote to other life priorities, including maintaining consistent employment. Participants described how VOT increased their autonomy, allowed them to keep treatment private, and normalized treatment to align with other medications that do not require in-person dosing. Participants did not describe major usability issues or privacy concerns with submitting videos. Some participants reported feeling disconnected from counselors while others felt more connected. Counselors felt some discomfort in their new role confirming medication ingestion but saw VOT as a useful tool for select patients. CONCLUSIONS VOT may be an acceptable tool to achieve equipoise between lowering barriers to treatment with methadone and protecting the health and safety of patients and their communities.
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Affiliation(s)
- James B Darnton
- Division of General Internal Medicine, University of Washington, 325 9th Ave, 359780, Seattle, WA, 98195, USA
- Evergreen Treatment Services, Seattle, WA, 98134, USA
| | - Elenore P Bhatraju
- Division of General Internal Medicine, University of Washington, 325 9th Ave, 359780, Seattle, WA, 98195, USA
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Alyssa Michaels
- Division of HIV, ID, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, 94110, USA
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Sean Soth
- Evergreen Treatment Services, Seattle, WA, 98134, USA
| | - Paul Grekin
- Evergreen Treatment Services, Seattle, WA, 98134, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | | | - Judith I Tsui
- Division of General Internal Medicine, University of Washington, 325 9th Ave, 359780, Seattle, WA, 98195, USA.
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Hallgren KA, Darnton J, Soth S, Blalock KL, Michaels A, Grekin P, Saxon AJ, Woolworth S, Tsui JI. Acceptability, feasibility, and outcomes of a clinical pilot program for video observation of methadone take-home dosing during the COVID-19 pandemic. J Subst Abuse Treat 2022; 143:108896. [PMID: 36215911 PMCID: PMC9531364 DOI: 10.1016/j.jsat.2022.108896] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/20/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Methadone is one of the most utilized treatments for opioid use disorder. However, requirements for observing methadone dosing can impose barriers to patients and increase risk for respiratory illness transmission (e.g., COVID-19). Video observation of methadone dosing at home could allow opioid treatment programs (OTPs) to offer more take-home doses while ensuring patient safety through remote observation of ingestion. METHODS Between April and August 2020, a clinical pilot program of video observation of methadone take-home dosing via smartphone was conducted within a multisite OTP agency. Participating patients completed a COVID-19 symptom screener and submitted video recordings of themselves ingesting all methadone take-home doses. Patients who followed these procedures for a two-week trial period could continue participating in the full pilot program and potentially receive more take-home doses. This retrospective observational study characterizes patient engagement and compares clinical outcomes with matched controls. RESULTS Of 44 patients who initiated the two-week trial, 33 (75 %) were successful and continued participating in the full pilot program. Twenty full pilot participants (61 %) received increased take-home doses. Full pilot participants had more days with observed dosing over a 60-day period than matched controls (mean = 53.2 vs. 16.6 days, respectively). Clinical outcomes were similar between pilot participants and matched controls. CONCLUSIONS Video observation of methadone take-home dosing implemented during the COVID-19 pandemic was feasible. This model has the potential to enhance safety by increasing rates of observed methadone dosing and reducing infection risks and barriers associated with relying solely on face-to-face observation of methadone dosing.
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Affiliation(s)
- Kevin A. Hallgren
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98195, United States,Corresponding author at: Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Box 356560, 1959 NE Pacific St., Seattle, WA 98195, United States
| | - James Darnton
- University of Washington, Division of General Internal Medicine, Seattle, WA 98195, United States,Evergreen Treatment Services, Seattle, WA 98134, United States
| | - Sean Soth
- Evergreen Treatment Services, Seattle, WA 98134, United States
| | - Kendra L. Blalock
- University of Washington, Division of General Internal Medicine, Seattle, WA 98195, United States
| | - Alyssa Michaels
- University of Washington, Division of General Internal Medicine, Seattle, WA 98195, United States
| | - Paul Grekin
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98195, United States,Evergreen Treatment Services, Seattle, WA 98134, United States
| | - Andrew J. Saxon
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98195, United States,Center of Excellence in Substance Addiction Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle, WA 98108, United States
| | - Steve Woolworth
- Evergreen Treatment Services, Seattle, WA 98134, United States
| | - Judith I. Tsui
- University of Washington, Division of General Internal Medicine, Seattle, WA 98195, United States
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McCrossan P, O'Donoghue D, McElnay JC, Shields MD. The use of remote video directly observed therapy to improve both inhaler technique and adherence to asthma medications. Front Public Health 2022; 10:965629. [PMID: 36276358 PMCID: PMC9581185 DOI: 10.3389/fpubh.2022.965629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/20/2022] [Indexed: 01/24/2023] Open
Abstract
Incorrect inhaler technique and non-adherence to inhaled preventer therapy often is the cause of poorly controlled asthma. Detecting and correcting non-adherence in asthma therapy has proven difficult. In addition, while patients may be able to demonstrate correct inhaler technique at the clinic recent evidence suggests that critical errors in inhaler technique occur in the home setting. Remote video directly observed therapy (vDOT) has recently been described as a potentially useful tool for addressing non-adherence while also allowing timely correction of inhaler technique errors. In this mini-review we describe the use of vDOT in asthma management.
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Affiliation(s)
- Paddy McCrossan
- Centre for Medical Education, Queen's University Belfast, Belfast, United Kingdom,Royal Belfast Hospital of Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Dara O'Donoghue
- Centre for Medical Education, Queen's University Belfast, Belfast, United Kingdom,Royal Belfast Hospital of Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | | | - Michael D. Shields
- Royal Belfast Hospital of Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom,Centre for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom,*Correspondence: Michael D. Shields
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Knaub RJ, Evans J, Yang C, Roura R, McGinn T, Verschoore B, Ricketts EP, Rothman RE, Latkin CA, Hsieh YH. A pilot study of a mixed-method approach to design an ED-based peer mHealth referral tool for HIV/HCV and opioid overdose prevention services. Drug Alcohol Depend 2022; 238:109585. [PMID: 35926299 PMCID: PMC9620482 DOI: 10.1016/j.drugalcdep.2022.109585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The intersecting epidemics of opioid misuse, injection drug use, and HIV/HCV have resulted in record overdose deaths and sustained high levels of HIV/HCV transmissions. Literature on social networks suggests opportunities to connect people who use drugs (PWUD) and their peers to HIV/HCV and opioid overdose prevention services. However, little evidence exists on how to design such peer referral interventions in emergency department (ED) settings. METHODS A mixed-method study was conducted to assess the feasibility of an mHealth-facilitated 'patient to peer social network referral program' for PWUD. In-depth interviews (IDIs) and quantitative surveys were conducted with urban ED patients (n = 15), along with 3 focus group discussions (FGDs) (n = 19). RESULTS Overall, 34 participants were enrolled (71 % males, 53 % Black). 13/15 IDI participants reported a history of opioid overdose; all had witnessed overdose events; all received HIV/HCV testing. From survey responses, most would invite their peers for HIV/HCV testing and naloxone training; and anticipated peers to accept referrals (HIV: 60 %, HCV: 73 %, naloxone: 93 %). Qualitative data showed PWUD shared health-related information with each other but preferred word of mouth rather than text messages. Participants used smartphones regularly and suggested using Internet advertising for prevention services. Participants expressed enthusiasm for ED-based peer mHealth referral platform to prevention services, as well as referring their peers to proposed services, with monetary incentives. CONCLUSION ED-based peer referral intervention to HIV/HCV testing and naloxone training was viewed favorably by PWUD. Frequent smartphone use among PWUD suggests that the medium could be a promising mode for peer referral.
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Affiliation(s)
- Ross J. Knaub
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Julie Evans
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Raúl Roura
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Tanner McGinn
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Benjamin Verschoore
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Erin P. Ricketts
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Richard E. Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Carl A. Latkin
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Sweeney MM, Holtyn AF, Stitzer ML, Gastfriend DR. Practical Technology for Expanding and Improving Substance Use Disorder Treatment: Telehealth, Remote Monitoring, and Digital Health Interventions. Psychiatr Clin North Am 2022; 45:515-528. [PMID: 36055736 PMCID: PMC9352538 DOI: 10.1016/j.psc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The US opioid crisis and the COVID-19 pandemic have sparked innovation in substance use disorder (SUD) treatment such that telehealth, remote monitoring, and digital health interventions are increasingly feasible and effective. These technologies can increase SUD treatment access and acceptability, even for nontreatment seeking, remote, and underserved populations, and can be used to reduce health disparities. Overall, digital tools will likely overcome many barriers to delivery of evidence-based behavioral treatments such as cognitive behavioral therapy and contingency management, that, along with appropriate medications, constitute the foundation of treatment of SUDs.
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Affiliation(s)
- Mary M Sweeney
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA; Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
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