1
|
Wenzel K, Mallik-Kane K, Anderson K, Fishman M. An Assertive Community Intervention to Engage Youth with Opioid Use Disorder and Their Families. Child Adolesc Psychiatr Clin N Am 2024; 33:709-728. [PMID: 39277321 DOI: 10.1016/j.chc.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Medications for opioid use disorder (MOUD) are the most effective treatment for OUD. Many patients struggle with adherence, but young adults face unique developmental barriers and experience higher relapse rates. The Youth Opioid Recovery Support (YORS) intervention is a developmentally informed behavioral approach to increase medication adherence through assertive outreach, family involvement, low-barrier access to extended-release MOUD, and contingency management. Early studies have shown promising results, and a randomized controlled trial is underway. Here we describe the implementation of YORS using case examples, offer guidance on adapting YORS to real-world clinical settings, and explore future directions for research and practice.
Collapse
Affiliation(s)
- Kevin Wenzel
- Maryland Treatment Centers, 3800 Frederick Avenue, Baltimore, MD 21229, USA
| | - Kamala Mallik-Kane
- Maryland Treatment Centers, 3800 Frederick Avenue, Baltimore, MD 21229, USA.
| | - Kathleen Anderson
- Maryland Treatment Centers, 3800 Frederick Avenue, Baltimore, MD 21229, USA
| | - Marc Fishman
- Maryland Treatment Centers, 3800 Frederick Avenue, Baltimore, MD 21229, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
2
|
Vacher C, Ho N, Skinner A, Crosland P, Hosseini SH, Huntley S, Song YJC, Lee GY, Natsky AN, Piper S, Hasudungan R, Rosenberg S, Occhipinti JA, Hickie IB. Reducing mental health emergency visits: population-level strategies from participatory modelling. BMC Psychiatry 2024; 24:627. [PMID: 39333997 PMCID: PMC11429926 DOI: 10.1186/s12888-024-06066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Emergency departments (EDs) are often the front door for urgent mental health care, especially when demand exceeds capacity. Long waits in EDs exert strain on hospital resources and worsen distress for individuals experiencing a mental health crisis. We used as a test case the Australian Capital Territory (ACT), with a population surge of over 27% across 2011-2021 and a lagging increase in mental health care capacity, to evaluate population-based approaches to reduce mental health-related ED presentations. METHODS We developed a system dynamics model for the ACT region using a participatory approach involving local stakeholders, including health planners, health providers and young people with lived experience of mental health disorders. Outcomes were projected over 2023-2032 for youth (aged 15-24) and for the general population. RESULTS Improving the overall mental health care system through strategies such as doubling the annual capacity growth rate of mental health services or leveraging digital technologies for triage and care coordination is projected to decrease youth mental health-related ED visits by 4.3% and 4.8% respectively. Implementation of mobile crisis response teams (consisting of a mental health nurse accompanying police or ambulance officers) is projected to reduce youth mental health-related ED visits by 10.2% by de-escalating some emergency situations and directly transferring selected individuals to community mental health centres. Other effective interventions include limiting re-presentations to ED by screening for suicide risk and following up with calls post-discharge (6.4% reduction), and limiting presentations of frequent users of ED by providing psychosocial education to families of people with schizophrenia (5.1% reduction). Finally, combining these five approaches is projected to reduce youth mental health-related ED presentations by 26.6% by the end of 2032. CONCLUSIONS Policies to decrease youth mental health-related ED presentations should not be limited to increasing mental health care capacity, but also include structural reforms.
Collapse
Grants
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
- "Right care, first time, where you live" program, supported by a $12.8 million partnership with the BHP Foundation BHP Foundation
Collapse
Affiliation(s)
- Catherine Vacher
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia.
| | - Nicholas Ho
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Adam Skinner
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Paul Crosland
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Seyed Hossein Hosseini
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Sam Huntley
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Yun Ju Christine Song
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Grace Yeeun Lee
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Andrea N Natsky
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Sarah Piper
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Raphael Hasudungan
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Sebastian Rosenberg
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| | - Jo-An Occhipinti
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
- Computer Simulation and Advanced Research Technologies (CSART), Sydney, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, 2050, Australia
| |
Collapse
|
3
|
Tak YW, Lee JW, Kim J, Lee Y. Predicting Long-Term Engagement in mHealth Apps: Comparative Study of Engagement Indices. J Med Internet Res 2024; 26:e59444. [PMID: 39250192 PMCID: PMC11420572 DOI: 10.2196/59444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/02/2024] [Accepted: 07/30/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND Digital health care apps, including digital therapeutics, have the potential to increase accessibility and improve patient engagement by overcoming the limitations of traditional facility-based medical treatments. However, there are no established tools capable of quantitatively measuring long-term engagement at present. OBJECTIVE This study aimed to evaluate an existing engagement index (EI) in a commercial health management app for long-term use and compare it with a newly developed EI. METHODS Participants were recruited from cancer survivors enrolled in a randomized controlled trial that evaluated the impact of mobile health apps on recovery. Of these patients, 240 were included in the study and randomly assigned to the Noom app (Noom Inc). The newly developed EI was compared with the existing EI, and a long-term use analysis was conducted. Furthermore, the new EI was evaluated based on adapted measurements from the Web Matrix Visitor Index, focusing on click depth, recency, and loyalty indices. RESULTS The newly developed EI model outperformed the existing EI model in terms of predicting EI of a 6- to 9-month period based on the EI of a 3- to 6-month period. The existing model had a mean squared error of 0.096, a root mean squared error of 0.310, and an R2 of 0.053. Meanwhile, the newly developed EI models showed improved performance, with the best one achieving a mean squared error of 0.025, root mean squared error of 0.157, and R2 of 0.610. The existing EI exhibited significant associations: the click depth index (hazard ratio [HR] 0.49, 95% CI 0.29-0.84; P<.001) and loyalty index (HR 0.17, 95% CI 0.09-0.31; P<.001) were significantly associated with improved survival, whereas the recency index exhibited no significant association (HR 1.30, 95% CI 1.70-2.42; P=.41). Among the new EI models, the EI with a menu combination of menus available in the app's free version yielded the most promising result. Furthermore, it exhibited significant associations with the loyalty index (HR 0.32, 95% CI 0.16-0.62; P<.001) and the recency index (HR 0.47, 95% CI 0.30-0.75; P<.001). CONCLUSIONS The newly developed EI model outperformed the existing model in terms of the prediction of long-term user engagement and compliance in a mobile health app context. We emphasized the importance of log data and suggested avenues for future research to address the subjectivity of the EI and incorporate a broader range of indices for comprehensive evaluation.
Collapse
Affiliation(s)
- Yae Won Tak
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Junetae Kim
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Republic of Korea
| | - Yura Lee
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
4
|
Mogk J, Idu AE, Bobb JF, Key D, Wong ES, Palazzo L, Stefanik-Guizlo K, King D, Beatty T, Dorsey CN, Caldeiro RM, Garza McWethy A, Glass JE. Prescription Digital Therapeutics for Substance Use Disorder in Primary Care: Mixed Methods Evaluation of a Pilot Implementation Study. JMIR Form Res 2024; 8:e59088. [PMID: 39222348 PMCID: PMC11406110 DOI: 10.2196/59088] [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] [Received: 04/03/2024] [Revised: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Delivering prescription digital therapeutics (ie, evidence-based interventions designed to treat, manage, or prevent disorders via websites or smartphone apps) in primary care could increase patient access to substance use disorder (SUD) treatments. However, the optimal approach to implementing prescription digital therapeutics in primary care remains unknown. OBJECTIVE This pilot study is a precursor to a larger trial designed to test whether implementation strategies (practice facilitation [PF] and health coaching [HC]) improve the delivery of prescription digital therapeutics for SUDs in primary care. This mixed methods study describes outcomes among patients in the 2 pilot clinics and presents qualitative findings on implementation. METHODS From February 10 to August 6, 2021, a total of 3 mental health specialists embedded in 2 primary care practices of the same integrated health system were tasked with offering app-based prescription digital therapeutics to patients with SUD. In the first half of the pilot, implementation activities included training and supportive tools. PF (at 1 clinic) and HC (at 2 clinics) were added in the second half. All study analyses relied on secondary data, including electronic health records and digital therapeutic vendor data. Primary outcomes were the proportion of patients reached by the prescription digital therapeutics and fidelity related to ideal use. We used qualitative methods to assess the adherence to planned activities and the barriers and facilitators to implementing prescription digital therapeutics. RESULTS Of all 18 patients prescribed the apps, 10 (56%) downloaded the app and activated their prescription, and 8 (44%) completed at least 1 module of content. Patients who activated the app completed 1 module per week on average. Ideal use (fidelity) was defined as completing 4 modules per week and having a monthly SUD-related visit; 1 (6%) patient met these criteria for 10 weeks (of the 12-week prescription period). A total of 5 (28%) patients had prescriptions while HC was available, 2 (11%) were successfully contacted, and both declined coaching. Clinicians reported competing clinical priorities, technical challenges, and logistically complex workflows in part because the apps required a prescription. Some pilot activities were impacted by staff turnover that coincided with the COVID-19 pandemic. The facilitators to implementation were high engagement and the perception that the apps could meet patient needs. CONCLUSIONS The pilot study encountered the barriers to implementing prescription digital therapeutics in a real-world primary care setting, especially staffing shortages, turnover, and competing priorities for clinic teams. The larger randomized trial will clarify the extent to which PF and HC improve the implementation of digital therapeutics. TRIAL REGISTRATION ClinicalTrials.gov NCT04907045; https://clinicaltrials.gov/study/NCT04907045.
Collapse
Affiliation(s)
- Jessica Mogk
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Abisola E Idu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Dustin Key
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Edwin S Wong
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - Lorella Palazzo
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | | | - Deborah King
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Caitlin N Dorsey
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Ryan M Caldeiro
- Mental Health and Wellness Services, Kaiser Permanente Washington, Renton, WA, United States
| | | | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| |
Collapse
|
5
|
Villanueva-Blasco VJ, Eslava D, Olave L, Torrens M. Electronic interventions in primary care to address substance use: A systematic review. Addict Behav 2024; 156:108073. [PMID: 38821009 DOI: 10.1016/j.addbeh.2024.108073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/02/2024]
Abstract
The present systematic review aims to identify electronic interventions for addressing substance use and understand their effectiveness in primary care settings. A systematic search was carried out in the Web of Science, PubMed/MEDLINE, Scopus, and Cochrane Library. The search included the keywords "electronic intervention", "substance use", "primary care" and synonyms. To determine the quality and recommendation of the analyzed interventions, the efficacy results reported by the studies were considered, as well as the Mixed Methods Appraisal Tool (MMAT) assessment and the GRADE Evidence Assessment. Twenty-one electronic interventions in Primary Care were identified: internet, mobile or tablet applications, text messages, emails, automated telephone calls, or electronic self-reports. These interventions had diverse components, incorporating theories that have proven effective in face-to-face interventions as their theoretical frameworks. Some of them were complementary to in-person treatment, while others replaced it. Six interventions (28.5 %) displayed high quality: HealthCall, AB-CASI, Quit Genius, eCHECKUP-TOGO, CBI, and TES. Another nine interventions (42.8 %) were found to have moderate-high quality: Alcohol y Salud, IVR-BI, Program of Wallace et al., Let's Talk About Smoking, SMSalud, ESCAPE, AAC-ASPIRE, iQuit, and Programa VIH. One intervention (4.7 %) had moderate-low quality: Vive sin tabaco ¡Decídete! The remaining five interventions (23.8 %) were found to have very low quality: Connection to health, cSBI, Teen Well Check, the program of Helzer et al. (2008), and Down your drink. The programs with the highest recommendation for addressing alcohol-related issues are HealthCall and AB-CASI; for tobacco use, it is Quit Genius; for cannabis use, it is eCHECKUP-TOGO; for addressing both legal and illegal substances, it is CBI and TES. Finally, for specific illicit drug use, the only recommended program is CBI. This last intervention, CBI, is of the highest quality and, therefore, can be considered a model intervention for dissemination in the primary care setting.
Collapse
Affiliation(s)
- Víctor J Villanueva-Blasco
- Faculty of Health Sciences, Valencian International University, C/ Pintor Sorolla, 21, 46002, Spain; Research Group on Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, Spain; Research Network in Primary Addiction Care (RIAPAd), Spain.
| | - Dalila Eslava
- Research Network in Primary Addiction Care (RIAPAd), Spain; Faculty of Human Sciences and Education, University of Zaragoza, Spain.
| | - Leticia Olave
- Faculty of Health Sciences, Valencian International University, C/ Pintor Sorolla, 21, 46002, Spain; Research Group on Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, Spain.
| | - Marta Torrens
- Research Network in Primary Addiction Care (RIAPAd), Spain; Addiction Research Group (GRAd), Neuroscience Research Program, Hospital del Mar Research Institute, Spain; School of Medicine, Universitat de Vic-Central de Catalunya (UCC), Spain.
| |
Collapse
|
6
|
Rothman B, Slomkowski M, Speier A, Rush AJ, Trivedi MH, Lawson E, Fahmy M, Carpenter D, Chen D, Forbes A. Evaluating the Efficacy of a Digital Therapeutic (CT-152) as an Adjunct to Antidepressant Treatment in Adults With Major Depressive Disorder: Protocol for the MIRAI Remote Study. JMIR Res Protoc 2024; 13:e56960. [PMID: 39163592 PMCID: PMC11372332 DOI: 10.2196/56960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/31/2024] [Accepted: 06/17/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is common worldwide and can be highly disabling. People with MDD face many barriers to treatment and may not experience full symptom relief even when treated. Therefore, new treatment modalities are needed for MDD. Digital therapeutics (DTx) may provide people with MDD an additional treatment option. OBJECTIVE This study aimed to describe a phase 3 remote, multicenter, randomized, masked, sham-controlled trial evaluating the efficacy of a smartphone app-based DTx (CT-152) in adult participants diagnosed with MDD, used as an adjunct to antidepressant therapy (ADT). METHODS Participants aged 22-64 years with a current primary diagnosis of MDD and an inadequate response to ADT were included. Participants were randomized 1:1 to CT-152 or a sham DTx. CT-152 is a smartphone app-based DTx that delivers a cognitive-emotional and behavioral therapeutic intervention. The core components of CT-152 are the Emotional Faces Memory Task exercises, brief lessons to learn and apply key therapeutic skills, and SMS text messaging to reinforce lessons and encourage engagement with the app. The sham DTx is a digital working memory exercise with emotionally neutral stimuli designed to match CT-152 for time and attention. Participants took part in the trial for up to 13 weeks. The trial included a screening period of up to 3 weeks, a treatment period of 6 weeks, and an extension period of 4 weeks to assess the durability of the effect. Sites and participants had the option of an in-person or remote screening visit; the remaining trial visits were remote. Efficacy was evaluated using the Montgomery-Åsberg Depression Rating Scale, the Generalized Anxiety Disorder-7, Clinical Global Impression-Severity scale, the Patient Health Questionnaire-9, and the World Health Organization Disability Assessment Schedule 2.0. The durability of the effect was evaluated with the Montgomery-Åsberg Depression Rating Scale and Generalized Anxiety Disorder-7 scale. Adverse events were also assessed. Satisfaction, measured by the Participant and Healthcare Professional Satisfaction Scales, and health status, measured by the EQ-5D-5L, were summarized using descriptive statistics. RESULTS This study was initiated in February 2021 and had a primary completion date in October 2022. CONCLUSIONS This represents the methodological design for the first evaluation of CT-152 as an adjunct to ADT. This study protocol is methodologically robust and incorporates many aspects of conventional pivotal pharmaceutical phase 3 trial design, such as randomization and safety end points. Novel considerations included the use of a sham comparator, masking considerations for visible app content, and outcome measures relevant to DTx. The rigor of this methodology will provide a more comprehensive understanding of the effectiveness of CT-152. TRIAL REGISTRATION ClinicalTrials.gov NCT04770285; https://clinicaltrials.gov/study/NCT04770285. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/56960.
Collapse
Affiliation(s)
- Brian Rothman
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | - Mary Slomkowski
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | - Austin Speier
- Click Therapeutics, Inc, New York, NY, United States
| | - A John Rush
- School of Medicine, Duke University, Durham, NC, United States
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
- O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Erica Lawson
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | - Michael Fahmy
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | | | - Dalei Chen
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | - Ainslie Forbes
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| |
Collapse
|
7
|
Kelley AT, Incze MA, Baumgartner M, Campbell ANC, Nunes EV, Scharfstein DO. Predictors of urine toxicology and other biologic specimen missingness in randomized trials of substance use disorders. Drug Alcohol Depend 2024; 261:111368. [PMID: 38896944 PMCID: PMC11405181 DOI: 10.1016/j.drugalcdep.2024.111368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/08/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND High levels of missing outcome data for biologically confirmed substance use (BCSU) threaten the validity of substance use disorder (SUD) clinical trials. Underlying attributes of clinical trials could explain BCSU missingness and identify targets for improved trial design. METHODS We reviewed 21 clinical trials funded by the NIDA National Drug Abuse Treatment Clinical Trials Network (CTN) and published from 2005 to 2018 that examined pharmacologic and psychosocial interventions for SUD. We used configurational analysis-a Boolean algebra approach that identifies an attribute or combination of attributes predictive of an outcome-to identify trial design features and participant characteristics associated with high levels of BCSU missingness. Associations were identified by configuration complexity, consistency, coverage, and robustness. We limited results using a consistency threshold of 0.75 and summarized model fit using the product of consistency and coverage. RESULTS For trial design features, the final solution consisted of two pathways: psychosocial treatment as a trial intervention OR larger trial arm size (complexity=2, consistency=0.79, coverage=0.93, robustness score=0.71). For participant characteristics, the final solution consisted of two pathways: interventions targeting individuals with poly- or nonspecific substance use OR younger age (complexity=2, consistency=0.75, coverage=0.86, robustness score=1.00). CONCLUSIONS Psychosocial treatments, larger trial arm size, interventions targeting individuals with poly- or nonspecific substance use, and younger age among trial participants were predictive of missing BCSU data in SUD clinical trials. Interventions to mitigate missing data that focus on these attributes may reduce threats to validity and improve utility of SUD clinical trials.
Collapse
Affiliation(s)
- A Taylor Kelley
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Vulnerable Veteran Patient-Aligned Care Team, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
| | - Michael A Incze
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Aimee N C Campbell
- New York State Psychiatric Institute, Division on Substance Use Disorders, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Edward V Nunes
- New York State Psychiatric Institute, Division on Substance Use Disorders, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel O Scharfstein
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
8
|
Belfort E, MacMillan C, Weigle P. Peril and Promise: Teens, Tech, and America's Mental Health Crisis. Child Adolesc Psychiatr Clin N Am 2024; 33:485-498. [PMID: 38823819 DOI: 10.1016/j.chc.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
Advances in Internet technologies have implications for the health and development of children and adolescents with potential for both beneficial and harmful outcomes. Similar technological advances also impact how psychiatrists deliver mental health care in clinical settings. Internet tech adds complexities to psychiatric practice in the form of electronic health records, patient portals, and virtual patient contact, which clinicians must understand and successfully incorporate into practice. Digital therapeutics and virtual mental health endeavors offer new treatment delivery options for patients and providers. Some have proven benefits, such as improved accessibility for patients, but all require provider expertise to utilize.
Collapse
Affiliation(s)
- Erin Belfort
- Maine Medical Center, 66 Bramhall Street, Portland, ME 04102, USA.
| | | | - Paul Weigle
- Natchaug Hospital, Hartford Healthcare, Mansfield Center, 89 Storrs Road, Mansfield, CT 06250-0260, USA; Department of Psychiatry, UConn School of Medicine, Farmington, USA
| |
Collapse
|
9
|
Moon KC, Sapra M, Alvarado GL. Not the Droids We're Looking for? Considering Mental Health Apps From a Disruptive Innovation Perspective. Psychiatr Serv 2024; 75:602-603. [PMID: 38823024 DOI: 10.1176/appi.ps.20230320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Affiliation(s)
- Khatiya C Moon
- Northwell Health, New Hyde Park, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Manish Sapra
- Northwell Health, New Hyde Park, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - George L Alvarado
- Northwell Health, New Hyde Park, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| |
Collapse
|
10
|
Oesterle TS, Hall-Flavin DK, Bormann NL, Loukianova LL, Fipps DC, Breitinger SA, Gilliam WP, Wu T, da Costa SC, Arndt S, Karpyak VM. Therapeutic Content of Mobile Phone Applications for Substance Use Disorders: An Umbrella Review. MAYO CLINIC PROCEEDINGS. DIGITAL HEALTH 2024; 2:192-206. [PMID: 38983444 PMCID: PMC11232654 DOI: 10.1016/j.mcpdig.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Mobile phone applications (MPAs) for substance use disorder (SUD) treatment are increasingly used by patients. Although pilot studies have shown promising results, multiple previous systematic reviews noted insufficient evidence for MPA use in SUD treatment-many of the previously published reviews evaluated different trials. Subsequently, we aimed to conduct an umbrella review of previously published reviews investigating the efficacy of MPAs for SUD treatment, excluding nicotine/tobacco because umbrella reviews have been done in this population and the nicotine/tobacco MPA approach often differs from SUD-focused MPAs. No previous reviews have included a statistical meta-analysis of clinical trials to quantify an estimated overall effect. Seven reviews met inclusion criteria, and 17 unique studies with available data were taken from those reviews for the meta-analysis. Overall, reviews reported a lack of evidence for recommending MPAs for SUD treatment. However, MPA-delivered recovery support services, cognitive behavioral therapy, and contingency management were identified across multiple reviews as having promising evidence for SUD treatment. Hedges g effect size for an MPA reduction in substance use-related outcomes relative to the control arm was insignificant (0.137; 95% CI, -0.056 to 0.330; P=.16). In subgroup analysis, contingency management (1.29; 95% CI, 1.088-1.482; τ 2=0; k=2) and cognitive behavioral therapy (0.02; 95% CI, 0.001-0.030; τ 2=0; k=2) were significant. Although contingency management's effect was large, both trials were small (samples of 40 and 30). This review includes an adapted framework for the American Psychiatric Association's MPA guidelines that clinicians can implement to review MPAs critically with patients.
Collapse
Affiliation(s)
- Tyler S Oesterle
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Daniel K Hall-Flavin
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Nicholas L Bormann
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Larissa L Loukianova
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - David C Fipps
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Scott A Breitinger
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Wesley P Gilliam
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Tiffany Wu
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Sabrina Correa da Costa
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Stephan Arndt
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Victor M Karpyak
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| |
Collapse
|
11
|
Song YM, Jeong J, de Los Reyes AA, Lim D, Cho CH, Yeom JW, Lee T, Lee JB, Lee HJ, Kim JK. Causal dynamics of sleep, circadian rhythm, and mood symptoms in patients with major depression and bipolar disorder: insights from longitudinal wearable device data. EBioMedicine 2024; 103:105094. [PMID: 38579366 PMCID: PMC11002811 DOI: 10.1016/j.ebiom.2024.105094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/14/2024] [Accepted: 03/17/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Sleep and circadian rhythm disruptions are common in patients with mood disorders. The intricate relationship between these disruptions and mood has been investigated, but their causal dynamics remain unknown. METHODS We analysed data from 139 patients (76 female, mean age = 23.5 ± 3.64 years) with mood disorders who participated in a prospective observational study in South Korea. The patients wore wearable devices to monitor sleep and engaged in smartphone-delivered ecological momentary assessment of mood symptoms. Using a mathematical model, we estimated their daily circadian phase based on sleep data. Subsequently, we obtained daily time series for sleep/circadian phase estimates and mood symptoms spanning >40,000 days. We analysed the causal relationship between the time series using transfer entropy, a non-linear causal inference method. FINDINGS The transfer entropy analysis suggested causality from circadian phase disturbance to mood symptoms in both patients with MDD (n = 45) and BD type I (n = 35), as 66.7% and 85.7% of the patients with a large dataset (>600 days) showed causality, but not in patients with BD type II (n = 59). Surprisingly, no causal relationship was suggested between sleep phase disturbances and mood symptoms. INTERPRETATION Our findings suggest that in patients with mood disorders, circadian phase disturbances directly precede mood symptoms. This underscores the potential of targeting circadian rhythms in digital medicine, such as sleep or light exposure interventions, to restore circadian phase and thereby manage mood disorders effectively. FUNDING Institute for Basic Science, the Human Frontiers Science Program Organization, the National Research Foundation of Korea, and the Ministry of Health & Welfare of South Korea.
Collapse
Affiliation(s)
- Yun Min Song
- Department of Mathematical Sciences, KAIST, Daejeon, 34141, Republic of Korea; Biomedical Mathematics Group, Pioneer Research Center for Mathematical and Computational Sciences, Institute for Basic Science, Daejeon, 34126, Republic of Korea
| | - Jaegwon Jeong
- Department of Psychiatry, Korea University College of Medicine, Seoul, 02841, Republic of Korea; Chronobiology Institute, Korea University, Seoul, 02841, Republic of Korea
| | - Aurelio A de Los Reyes
- Biomedical Mathematics Group, Pioneer Research Center for Mathematical and Computational Sciences, Institute for Basic Science, Daejeon, 34126, Republic of Korea; Institute of Mathematics, University of the Philippines Diliman, Quezon City, 1101, Philippines
| | - Dongju Lim
- Department of Mathematical Sciences, KAIST, Daejeon, 34141, Republic of Korea; Biomedical Mathematics Group, Pioneer Research Center for Mathematical and Computational Sciences, Institute for Basic Science, Daejeon, 34126, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, 02841, Republic of Korea; Chronobiology Institute, Korea University, Seoul, 02841, Republic of Korea
| | - Ji Won Yeom
- Department of Psychiatry, Korea University College of Medicine, Seoul, 02841, Republic of Korea; Chronobiology Institute, Korea University, Seoul, 02841, Republic of Korea
| | - Taek Lee
- Division of Computer Science and Engineering, Sun Moon University, Asan, 31460, Republic of Korea
| | - Jung-Been Lee
- Division of Computer Science and Engineering, Sun Moon University, Asan, 31460, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, 02841, Republic of Korea; Chronobiology Institute, Korea University, Seoul, 02841, Republic of Korea.
| | - Jae Kyoung Kim
- Department of Mathematical Sciences, KAIST, Daejeon, 34141, Republic of Korea; Biomedical Mathematics Group, Pioneer Research Center for Mathematical and Computational Sciences, Institute for Basic Science, Daejeon, 34126, Republic of Korea.
| |
Collapse
|
12
|
The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder. J Addict Med 2024; 18:1-56. [PMID: 38669101 PMCID: PMC11105801 DOI: 10.1097/adm.0000000000001299] [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: 04/28/2024]
Abstract
The American Society of Addiction Medicine/American Academy of Addiction Psychiatry (ASAM/AAAP) Clinical Practice Guideline on the Management of Stimulant Use Disorder provides guidance on evidence-based strategies for the treatment of stimulant use disorders (StUDs), stimulant intoxication, and stimulant withdrawal, as well as secondary and tertiary prevention of harms associated with stimulant use. The Clinical Guideline Committee (CGC) comprised experts from ASAM and AAAP representing a range of clinical settings and patient populations. The guideline was developed following modified GRADE methodology. The process included a systematic literature review as well as several targeted supplemental searches. The CGC utilized Evidence to Decision tables to review available evidence and rate the strength of each recommendation. The clinical practice guideline was revised based on external stakeholder review. Key takeaways included: Contingency management represents the current standard of care for treatment of StUDs; Pharmacotherapies may be utilized off-label to treat StUDs; Acute stimulant intoxication can result in life-threatening complications that should be addressed in an appropriate level of care; Secondary and tertiary prevention strategies should be used to reduce harms related to risky stimulant use.
Collapse
|
13
|
Kim YG, Brandt L, Cheung K, Nunes EV, Roll J, Luo SX, Liu Y. Optimizing Contingency Management with Reinforcement Learning. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.28.24305031. [PMID: 38585900 PMCID: PMC10996730 DOI: 10.1101/2024.03.28.24305031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Contingency Management (CM) is a psychological treatment that aims to change behavior with financial incentives. In substance use disorders (SUDs), deployment of CM has been enriched by longstanding discussions around the cost-effectiveness of prized-based and voucher-based approaches. In prize-based CM, participants earn draws to win prizes, including small incentives to reduce costs, and the number of draws escalates depending on the duration of maintenance of abstinence. In voucher-based CM, participants receive a predetermined voucher amount based on specific substance test results. While both types have enhanced treatment outcomes, there is room for improvement in their cost-effectiveness: the voucher-based system requires enduring financial investment; the prize-based system might sacrifice efficacy. Previous work in computational psychiatry of SUDs typically employs frameworks wherein participants make decisions to maximize their expected compensation. In contrast, we developed new frameworks that clinical decision-makers choose actions, CM structures, to reinforce the substance abstinence behavior of participants. We consider the choice of the voucher or prize to be a sequential decision, where there are two pivotal parameters: the prize probability for each draw and the escalation rule determining the number of draws. Recent advancements in Reinforcement Learning, more specifically, in off-policy evaluation, afforded techniques to estimate outcomes for different CM decision scenarios from observed clinical trial data. We searched CM schemas that maximized treatment outcomes with budget constraints. Using this framework, we analyzed data from the Clinical Trials Network to construct unbiased estimators on the effects of new CM schemas. Our results indicated that the optimal CM schema would be to strengthen reinforcement rapidly in the middle of the treatment course. Our estimated optimal CM policy improved treatment outcomes by 32% while maintaining costs. Our methods and results have broad applications in future clinical trial planning and translational investigations on the neurobiological basis of SUDs.
Collapse
Affiliation(s)
- Young-Geun Kim
- Mailman School of Public Health, Department of Biostatistics, New York, NY, USA
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY, USA
| | - Laura Brandt
- City College of New York, Department of Psychology, New York, NY, USA
| | - Ken Cheung
- Mailman School of Public Health, Department of Biostatistics, New York, NY, USA
| | - Edward V Nunes
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY, USA
- New York State Psychiatric Institute, Division on Substance Use Disorders, New York, NY, USA
| | - John Roll
- Washington State University, Department of Community and Behavioral Health, Spokane, WA, USA
- Washington State University, Program of Excellence in Addictions Research, Spokane, WA, USA
| | - Sean X Luo
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY, USA
- New York State Psychiatric Institute, Division on Substance Use Disorders, New York, NY, USA
| | - Ying Liu
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY, USA
| |
Collapse
|
14
|
Minozzi S, Saulle R, Amato L, Traccis F, Agabio R. Psychosocial interventions for stimulant use disorder. Cochrane Database Syst Rev 2024; 2:CD011866. [PMID: 38357958 PMCID: PMC10867898 DOI: 10.1002/14651858.cd011866.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Stimulant use disorder is a continuously growing medical and social burden without approved medications available for its treatment. Psychosocial interventions could be a valid approach to help people reduce or cease stimulant consumption. This is an update of a Cochrane review first published in 2016. OBJECTIVES To assess the efficacy and safety of psychosocial interventions for stimulant use disorder in adults. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, three other databases, and two trials registers in September 2023. All searches included non-English language literature. We handsearched the references of topic-related systematic reviews and the included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any psychosocial intervention with no intervention, treatment as usual (TAU), or a different intervention in adults with stimulant use disorder. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included a total of 64 RCTs (8241 participants). Seventy-three percent of studies included participants with cocaine or crack cocaine use disorder; 3.1% included participants with amphetamine use disorder; 10.9% included participants with methamphetamine use disorder; and 12.5% included participants with any stimulant use disorder. In 18 studies, all participants were in methadone maintenance treatment. In our primary comparison of any psychosocial treatment to no intervention, we included studies which compared a psychosocial intervention plus TAU to TAU alone. In this comparison, 12 studies evaluated cognitive behavioural therapy (CBT), 27 contingency management, three motivational interviewing, one study looked at psychodynamic therapy, and one study evaluated CBT plus contingency management. We also compared any psychosocial intervention to TAU. In this comparison, seven studies evaluated CBT, two contingency management, two motivational interviewing, and one evaluated a combination of CBT plus motivational interviewing. Seven studies compared contingency management reinforcement related to abstinence versus contingency management not related to abstinence. Finally, seven studies compared two different psychosocial approaches. We judged 65.6% of the studies to be at low risk of bias for random sequence generation and 19% at low risk for allocation concealment. Blinding of personnel and participants was not possible for the type of intervention, so we judged all the studies to be at high risk of performance bias for subjective outcomes but at low risk for objective outcomes. We judged 22% of the studies to be at low risk of detection bias for subjective outcomes. We judged most of the studies (69%) to be at low risk of attrition bias. When compared to no intervention, we found that psychosocial treatments: reduce the dropout rate (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.74 to 0.91; 30 studies, 4078 participants; high-certainty evidence); make little to no difference to point abstinence at the end of treatment (RR 1.15, 95% CI 0.94 to 1.41; 12 studies, 1293 participants; high-certainty evidence); make little to no difference to point abstinence at the longest follow-up (RR 1.22, 95% CI 0.91 to 1.62; 9 studies, 1187 participants; high-certainty evidence); probably increase continuous abstinence at the end of treatment (RR 1.89, 95% CI 1.20 to 2.97; 12 studies, 1770 participants; moderate-certainty evidence); may make little to no difference in continuous abstinence at the longest follow-up (RR 1.14, 95% CI 0.89 to 1.46; 4 studies, 295 participants; low-certainty evidence); reduce the frequency of drug intake at the end of treatment (standardised mean difference (SMD) -0.35, 95% CI -0.50 to -0.19; 10 studies, 1215 participants; high-certainty evidence); and increase the longest period of abstinence (SMD 0.54, 95% CI 0.41 to 0.68; 17 studies, 2118 participants; high-certainty evidence). When compared to TAU, we found that psychosocial treatments reduce the dropout rate (RR 0.79, 95% CI 0.65 to 0.97; 9 studies, 735 participants; high-certainty evidence) and may make little to no difference in point abstinence at the end of treatment (RR 1.67, 95% CI 0.64 to 4.31; 1 study, 128 participants; low-certainty evidence). We are uncertain whether they make any difference in point abstinence at the longest follow-up (RR 1.31, 95% CI 0.86 to 1.99; 2 studies, 124 participants; very low-certainty evidence). Compared to TAU, psychosocial treatments may make little to no difference in continuous abstinence at the end of treatment (RR 1.18, 95% CI 0.92 to 1.53; 1 study, 128 participants; low-certainty evidence); probably make little to no difference in the frequency of drug intake at the end of treatment (SMD -1.17, 95% CI -2.81 to 0.47, 4 studies, 479 participants, moderate-certainty evidence); and may make little to no difference in the longest period of abstinence (SMD -0.16, 95% CI -0.54 to 0.21; 1 study, 110 participants; low-certainty evidence). None of the studies for this comparison assessed continuous abstinence at the longest follow-up. Only five studies reported harms related to psychosocial interventions; four of them stated that no adverse events occurred. AUTHORS' CONCLUSIONS This review's findings indicate that psychosocial treatments can help people with stimulant use disorder by reducing dropout rates. This conclusion is based on high-certainty evidence from comparisons of psychosocial interventions with both no treatment and TAU. This is an important finding because many people with stimulant use disorders leave treatment prematurely. Stimulant use disorders are chronic, lifelong, relapsing mental disorders, which require substantial therapeutic efforts to achieve abstinence. For those who are not yet able to achieve complete abstinence, retention in treatment may help to reduce the risks associated with stimulant use. In addition, psychosocial interventions reduce stimulant use compared to no treatment, but they may make little to no difference to stimulant use when compared to TAU. The most studied and promising psychosocial approach is contingency management. Relatively few studies explored the other approaches, so we cannot rule out the possibility that the results were imprecise due to small sample sizes.
Collapse
Affiliation(s)
- Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Francesco Traccis
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| |
Collapse
|
15
|
Bright AM, Higgins A, Grealish A. How effective are digital/e-health interventions for supporting prisoners with mental ill-health? An integrative review. INTERNATIONAL JOURNAL OF PRISON HEALTH 2024; 20:75-87. [PMID: 38984557 DOI: 10.1108/ijoph-09-2022-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
PURPOSE There has been a move towards the implementation of digital/e-health interventions for some time. Digital/e-health interventions have demonstrable efficacy in increasing individual empowerment, providing timely access to psychological interventions for those experiencing mental ill-health and improving outcomes for those using them. This study aims to determine the efficacy of digital/e-health interventions for individuals detained in prison who experience mental ill-health. DESIGN/METHODOLOGY/APPROACH A systematic search of five academic databases - CINAHL, ASSIA, PsycINFO, Embase and Medline - was completed in December 2020 and updated in February 2022. The review was guided by the Whittemore and Knafl (2005) framework for integrative reviews. A total of 6,255 studies were returned and screened by title and abstract. A full-text screening of nine (n = 9) studies was conducted. FINDINGS No study met the inclusion criteria for the clinical efficacy of digital/e-health interventions in a prison setting. Subsequently, a review of the literature that made it to the full-text review stage was conducted, and gaps in the literature were identified to inform policy, practice and future research. ORIGINALITY/VALUE To the best of the authors' knowledge, this is the first integrative review conducted on the efficacy of digital/e-health interventions for mental ill-health in prison settings.
Collapse
Affiliation(s)
- Ann-Marie Bright
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Annmarie Grealish
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland and Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| |
Collapse
|
16
|
Campbell ANC, Rieckmann T, Pavlicova M, Choo TH, Molina K, McDonell M, West AE, Daw R, Marsch LA, Venner KL. Culturally tailored digital therapeutic for substance use disorders with urban Indigenous people in the United States: A randomized controlled study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209159. [PMID: 37690525 PMCID: PMC10872747 DOI: 10.1016/j.josat.2023.209159] [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: 11/10/2022] [Revised: 06/15/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Indigenous people experience health disparities, including higher rates of substance use disorders (SUDs). Digital therapeutics are a growing platform for treatment services and have the potential to expand access to culturally responsive interventions for Indigenous people. As one of the first randomized controlled trials for SUDs for American Indian and Alaska Native (AI/AN) adults, the aim of this study was to pilot test the efficacy of a culturally tailored intervention among urban Indigenous adults. METHODS The study used a randomized controlled parallel design of 12 weeks of treatment-as-usual (TAU) (n = 26) versus TAU + Therapeutic Education System-Native Version (TES-NAV) (n = 27) with follow-up assessments at end of treatment and week 24 in an urban outpatient addiction treatment program for Native American adults. TAU consisted of individual/group counseling and cultural activities. The TES-NAV arm comprised TAU + 26 self-directed culturally tailored digital skills-based modules grounded in the community reinforcement approach with contingency management for abstinence and module completion. Primary outcome was longest consecutive weeks of abstinence from drugs and heavy drinking measured using self-report (Timeline Followback) and urine alcohol and drug toxicology screen during 12 weeks of treatment. Secondary outcomes were percent days abstinence during and posttreatment, coping strategies, social connectedness, and substance use and sexual risk behaviors. RESULTS The study enrolled fifty-three (52.8 % male) AI/AN adults seeking treatment for a SUD. Although the study did not detect a benefit of TAU+TES-NAV over TAU on the primary outcome (Median = 2 consecutive weeks of abstinence for both arms) at end of treatment (treatment effect: Z = -0.78, p = 0.437), TAU+TES-NAV participants did demonstrate significantly greater percent days of abstinence at the week 24 follow-up (69.3 % versus 49.0 % for TAU; t = 2.08, p = 0.045) and significantly greater change in social connectedness mean score, baseline to week 12 (Z = -2.66, p = 0.011), compared to TAU. The study detected no differences between treatment arms for coping strategies or risk behaviors. CONCLUSION The addition of TES-NAV to TAU did not significantly improve consecutive weeks of abstinence from drugs or heavy drinking; however, several secondary findings suggest promise for a culturally tailored digital therapeutic SUD intervention among urban Indigenous people. CLINICAL TRIALS GOV REGISTRATION: #NCT03363256.
Collapse
Affiliation(s)
- Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive Box 120, New York, NY 10032, USA.
| | - Traci Rieckmann
- School of Medicine, Oregon Health & Science University, 3015 NE 44th Ave, Portland, OR 97213, USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168th St, 6th floor, Room 635, New York, NY 10032, USA
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive Box 120, New York, NY 10032, USA
| | - Kelly Molina
- Native American Rehabilitation Association of the Northwest, Inc., 1631 SW Columbia St, Portland, OR 97201, USA
| | - Michael McDonell
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA 99202, USA
| | - Amy E West
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4640 W. Sunset Blvd, Los Angeles, CA 90027, USA
| | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd, Hanover, NH 03755, USA
| | - Kamilla L Venner
- Department of Psychology and Center on Alcohol Substance use & Addiction (CASAA), University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131, USA
| |
Collapse
|
17
|
Grayek E, Krishnamurti T, Hu L, Babich O, Warren K, Fischhoff B. Collection and Analysis of Adherence Information for Software as a Medical Device Clinical Trials: Systematic Review. JMIR Mhealth Uhealth 2023; 11:e46237. [PMID: 37966871 PMCID: PMC10687688 DOI: 10.2196/46237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/31/2023] [Accepted: 08/25/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The rapid growth of digital health apps has necessitated new regulatory approaches to ensure compliance with safety and effectiveness standards. Nonadherence and heterogeneous user engagement with digital health apps can lead to trial estimates that overestimate or underestimate an app's effectiveness. However, there are no current standards for how researchers should measure adherence or address the risk of bias imposed by nonadherence through efficacy analyses. OBJECTIVE This systematic review aims to address 2 critical questions regarding clinical trials of software as a medical device (SaMD) apps: How well do researchers report adherence and engagement metrics for studies of effectiveness and efficacy? and What efficacy analyses do researchers use to account for nonadherence and how appropriate are their methods? METHODS We searched the Food and Drug Administration's registration database for registrations of repeated-use, patient-facing SaMD therapeutics. For each such registration, we searched ClinicalTrials.gov, company websites, and MEDLINE for the corresponding clinical trial and study articles through March 2022. Adherence and engagement data were summarized for each of the 24 identified articles, corresponding to 10 SaMD therapeutics. Each article was analyzed with a framework developed using the Cochrane risk-of-bias questions to estimate the potential effects of imperfect adherence on SaMD effectiveness. This review, funded by the Richard King Mellon Foundation, is registered on the Open Science Framework. RESULTS We found that although most articles (23/24, 96%) reported collecting information about SaMD therapeutic engagement, of the 20 articles for apps with prescribed use, only 9 (45%) reported adherence information across all aspects of prescribed use: 15 (75%) reported metrics for the initiation of therapeutic use, 16 (80%) reported metrics reporting adherence between the initiation and discontinuation of the therapeutic (implementation), and 4 (20%) reported the discontinuation of the therapeutic (persistence). The articles varied in the reported metrics. For trials that reported adherence or engagement, there were 4 definitions of initiation, 8 definitions of implementation, and 4 definitions of persistence. All articles studying a therapeutic with a prescribed use reported effectiveness estimates that might have been affected by nonadherence; only a few (2/20, 10%) used methods appropriate to evaluate efficacy. CONCLUSIONS This review identifies 5 areas for improving future SaMD trials and studies: use consistent metrics for reporting adherence, use reliable adherence metrics, preregister analyses for observational studies, use less biased efficacy analysis methods, and fully report statistical methods and assumptions.
Collapse
Affiliation(s)
- Emily Grayek
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Tamar Krishnamurti
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lydia Hu
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Olivia Babich
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Katherine Warren
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Baruch Fischhoff
- Department of Engineering and Public Policy, Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, PA, United States
| |
Collapse
|
18
|
Zhu K, Liu H. Pair-switching rerandomization. Biometrics 2023; 79:2127-2142. [PMID: 35758335 DOI: 10.1111/biom.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
Rerandomization discards assignments with covariates unbalanced in the treatment and control groups to improve estimation and inference efficiency. However, the acceptance-rejection sampling method used in rerandomization is computationally inefficient. As a result, it is time-consuming for rerandomization to draw numerous independent assignments, which are necessary for performing Fisher randomization tests and constructing randomization-based confidence intervals. To address this problem, we propose a pair-switching rerandomization (PSRR) method to draw balanced assignments efficiently. We obtain the unbiasedness and variance reduction of the difference-in-means estimator and show that the Fisher randomization tests are valid under PSRR. Moreover, we propose an exact approach to invert Fisher randomization tests to confidence intervals, which is faster than the existing methods. In addition, our method is applicable to both nonsequentially and sequentially randomized experiments. We conduct comprehensive simulation studies to compare the finite-sample performance of the proposed method with that of classical rerandomization. Simulation results indicate that PSRR leads to comparable power of Fisher randomization tests and is 3-23 times faster than classical rerandomization. Finally, we apply the PSRR method to analyze two clinical trial datasets, both of which demonstrate the advantages of our method.
Collapse
Affiliation(s)
- Ke Zhu
- Center for Statistical Science, Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Hanzhong Liu
- Center for Statistical Science, Department of Industrial Engineering, Tsinghua University, Beijing, China
| |
Collapse
|
19
|
Ruksakulpiwat S, Zhou W, Niyomyart A, Wang T, Kudlowitz A. How does the COVID-19 pandemic impact medication adherence of patients with chronic disease?: A systematic review. Chronic Illn 2023; 19:495-513. [PMID: 35971949 PMCID: PMC9382573 DOI: 10.1177/17423953221110151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/02/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine how the COVID-19 pandemic impacts patients with chronic disease medication adherence. METHODS Four electronic databases, PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text, were searched for literature between 2019 and 2021. Abstracts and later full texts were independently screened by the authors of this review using inclusion and exclusion criteria to determine relevance to our study. Joanna Briggs Institute (JBI) critical appraisal tools were used to assess the quality of included texts. Relevant information and data from the included texts were extracted into tables for data synthesis and analysis. RESULTS Ten studies met the study criteria, the most popular study design was cross-sectional design (n = 9, 90.0%), others were case series (n = 1, 10.0%). Barriers to medication adherence and facilitators of medication adherence were the major two themes that participants reported regarding the impact of COVID-19 on medication adherence. Moreover, these two main themes have been organized in sub-themes that are dealt with in-depth. DISCUSSION Our results could heighten healthcare providers, stakeholders, and policy leaders' awareness of providing appropriate support for chronic disease patients, especially regarding medication adherence. Future research incorporating programs that support patients' needs is recommended.
Collapse
Affiliation(s)
- Suebsarn Ruksakulpiwat
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Wendie Zhou
- School of Nursing, Peking University, Beijing, China
| | - Atsadaporn Niyomyart
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tongyao Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Aaron Kudlowitz
- The College of Arts and Sciences, Case Western Reserve University, Cleveland, USA
| |
Collapse
|
20
|
Ribba B, Peck R, Hutchinson L, Bousnina I, Motti D. Digital Therapeutics as a New Therapeutic Modality: A Review from the Perspective of Clinical Pharmacology. Clin Pharmacol Ther 2023; 114:578-590. [PMID: 37392464 DOI: 10.1002/cpt.2989] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/24/2023] [Indexed: 07/03/2023]
Abstract
The promise of transforming digital technologies into treatments is what drives the development of digital therapeutics (DTx), generally known as software applications embedded within accessible technologies-such as smartphones-to treat, manage, or prevent a pathological condition. Whereas DTx solutions that successfully demonstrate effectiveness and safety could drastically improve the life of patients in multiple therapeutic areas, there is a general consensus that generating therapeutic evidence for DTx presents challenges and open questions. We believe there are three main areas where the application of clinical pharmacology principles from the drug development field could benefit DTx development: the characterization of the mechanism of action, the optimization of the intervention, and, finally, its dosing. We reviewed DTx studies to explore how the field is approaching these topics and to better characterize the challenges associated with them. This leads us to emphasize the role that the application of clinical pharmacology principles could play in the development of DTx and to advocate for a development approach that merges such principles from development of traditional therapeutics with important considerations from the highly attractive and fast-paced world of digital solutions.
Collapse
Affiliation(s)
- Benjamin Ribba
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Richard Peck
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Lucy Hutchinson
- Roche Information Solutions, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Imein Bousnina
- Genentech, A Member of the Roche Group, Washington, DC, USA
| | - Dario Motti
- Roche Information Solutions, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| |
Collapse
|
21
|
Hutton HE, Aggarwal S, Gillani A, Chander G. A Digital Counselor-Delivered Intervention for Substance Use Among People With HIV: Development and Usability Study. JMIR Form Res 2023; 7:e40260. [PMID: 37639294 PMCID: PMC10495853 DOI: 10.2196/40260] [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: 06/13/2022] [Revised: 03/25/2023] [Accepted: 06/22/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Substance use disorders are prevalent and undertreated among people with HIV. Computer-delivered interventions (CDIs) show promise in expanding reach, delivering evidence-based care, and offering anonymity. Use in HIV clinic settings may overcome access barriers. Incorporating digital counselors may increase CDI engagement, and thereby improve health outcomes. OBJECTIVE We aim to develop and pilot a digital counselor-delivered brief intervention for people with HIV who use drugs, called "C-Raven," which is theory grounded and uses evidence-based practices for behavior change. METHODS Intervention mapping was used to develop the CDI including a review of the behavior change research in substance use, HIV, and digital counselors. We conducted in-depth interviews applying the situated-information, motivation, and behavior skills model and culturally adapting the content for local use with people with HIV. With a user interaction designer, we created various digital counselors and CDI interfaces. Finally, a mixed methods approach using in-depth interviews and quantitative assessments was used to assess the usability, acceptability, and cultural relevance of the intervention content and the digital counselor. RESULTS Participants found CDI easy to use, useful, relevant, and motivating. A consistent suggestion was to provide more information about the negative impacts of drug use and the interaction of drug use with HIV. Participants also reported that they learned new information about drug use and its health effects. The CDI was delivered by a "Raven," digital counselor, programmed to interact in a motivational interviewing style. The Raven was perceived to be nonjudgmental, understanding, and emotionally responsive. The appearance and images in the intervention were perceived as relevant and acceptable. Participants noted that they could be more truthful with a digital counselor, however, it was not unanimously endorsed as a replacement for a human counselor. The C-Raven Satisfaction Scale showed that all participants rated their satisfaction at either a 4 (n=2) or a 5 (n=8) on a 5-point Likert scale and all endorsed using the C-Raven program again. CONCLUSIONS CDIs show promise in extending access to care and improving health outcomes but their development necessarily requires integration from multiple disciplines including behavioral medicine and computer science. We developed a cross-platform compatible CDI led by a digital counselor that interacts in a motivational interviewing style and (1) uses evidence-based behavioral change methods, (2) is culturally adapted to people with HIV who use drugs, (3) has an engaging and interactive user interface, and (4) presents personalized content based on participants' ongoing responses to a series of menu-driven conversations. To advance the continued development of this and other CDIs, we recommend expanded testing, standardized measures to evaluate user experience, integration with clinician-delivered substance use treatment, and if effective, implementation into HIV clinical care.
Collapse
Affiliation(s)
- Heidi E Hutton
- Department of Psychiatry & Behaviorial Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Saavitri Aggarwal
- Department of Psychiatry & Behaviorial Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Afroza Gillani
- College of Dentistry, New York University, New York, NY, United States
| | - Geetanjali Chander
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, United States
| |
Collapse
|
22
|
Brandt L, Hu MC, Nunes EV, Campbell ANC. Exploring the performance of during-treatment substance use outcome measures in predicting longer-term psychosocial functioning and post-treatment abstinence. Drug Alcohol Depend 2023; 248:109918. [PMID: 37224673 PMCID: PMC10680067 DOI: 10.1016/j.drugalcdep.2023.109918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The selection of appropriate efficacy endpoints in clinical trials has been a long-standing challenge for the substance use disorder field. Using data from a large, multi-site National Drug Abuse Treatment Clinical Trials Network trial (CTN-0044; n=474), this secondary data analysis aimed to explore whether specific proximal (during-treatment) substance use outcome measures predict longer-term improvements in psychosocial functioning and post-treatment abstinence, and whether predictions vary depending on the specific substance (cannabis, cocaine/stimulants, opioids, and alcohol). METHODS Generalized linear mixed models examined associations between six during-treatment substance use outcome measures and social functioning impairment (Social Adjustment Scale Self-Report) and severity of psychiatric symptoms (Brief Symptom Inventory-18) at end-of-treatment, and 3- and 6-months after treatment as well as post-treatment abstinence. RESULTS Maximum days of consecutive abstinence, proportion of days abstinent, ≥3 weeks of continuous abstinence, and the proportion of urine specimens negative for the primary substance were associated with post-treatment psychiatric and social functioning improvement and abstinence. However, only the effects of abstinence during the last 4 weeks of the treatment period on all three post-treatment outcomes was stable over time and did not differ between primary substance groups. In contrast, complete abstinence during the 12-week treatment period was not consistently associated with functioning improvements. CONCLUSIONS Substance use outcome measures capturing the duration of primary substance abstinence during treatment are suitable predictors of post-treatment abstinence and longer-term psychosocial functioning improvement. Binary outcomes, such as end-of-treatment abstinence, may be particularly stable predictors and attractive given their ease of computation and straightforward clinical interpretability.
Collapse
Affiliation(s)
- Laura Brandt
- Department for Psychology, The City College of New York, New York, NY, USA.
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Edward V Nunes
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
23
|
Fast N, van Kessel R, Humphreys K, Ward NF, Roman-Urrestarazu A. The Evolution of Telepsychiatry for Substance Use Disorders During COVID-19: a Narrative Review. CURRENT ADDICTION REPORTS 2023; 10:187-197. [PMID: 37266192 PMCID: PMC10126560 DOI: 10.1007/s40429-023-00480-9] [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: 04/06/2023] [Indexed: 06/03/2023]
Abstract
Purpose of Review This article aims to review and synthesize the current research evidence regarding the efficacy of telepsychiatry-delivered substance use disorder treatment using a narrative review with a focus on the effects of remote healthcare delivery within the substance abuse treatment space. Recent Findings The COVID-19 pandemic exerted substantial pressures on all levels of society. Social isolation, loss of employment, stress, physical illness, overburdened health services, unmet medical needs, and rapidly changing pandemic restrictions had particularly severe consequences for people with mental health issues and substance use disorders. Since the start of the pandemic, addiction treatment (and medical treatment overall) using remote health platforms has significantly expanded to different platforms and delivery systems. The USA, in particular, reported transformational policy developments to enable the delivery of telehealth during the COVID-19 pandemic. However, systemic barriers such as a widespread lack of internet access and insufficient patient and provider digital skills remain. Summary Overall, telepsychiatry is a promising approach for the treatment of substance use disorders, but more randomized controlled trials are needed in the future to assess the evidence base of available interventions.
Collapse
Affiliation(s)
- Noam Fast
- START Treatment & Recovery Centers, New York City, USA
- Addiction Psychiatry Fellowship Faculty, Department of Psychiatry, Columbia University, New York City, USA
| | - Robin van Kessel
- Department of Health Policy, London School of Economics and Political Science, LSE Health, London, UK
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Natalie Frances Ward
- Department of International Development Studies, University of Amsterdam, Amsterdam, Netherlands
| | - Andres Roman-Urrestarazu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| |
Collapse
|
24
|
Raynor P, Corbett C, West D, Johnston D, Eichelberger K, Litwin A, Guille C, Prinz R. Leveraging Digital Technology to Support Pregnant and Early Parenting Women in Recovery from Addictive Substances: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4457. [PMID: 36901467 PMCID: PMC10002058 DOI: 10.3390/ijerph20054457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Little is known about digital health interventions used to support treatment for pregnant and early parenting women (PEPW) with substance use disorders (SUD). METHODS Guided by the Arksey and O'Malley's Scoping Review Framework, empirical studies were identified within the CINAHL, PsycInfo, PubMed, and ProQuest databases using subject headings and free-text keywords. Studies were selected based on a priori inclusion/exclusion criteria, and data extraction and descriptive analysis were performed. RESULTS A total of 27 original studies and 30 articles were included. Varying study designs were used, including several feasibility and acceptability studies. However, efficacious findings on abstinence and other clinically important outcomes were reported in several studies. Most studies focused on digital interventions for pregnant women (89.7%), suggesting a dearth of research on how digital technologies may support early parenting women with SUD. No studies included PEPW family members or involved PEPW women in the intervention design. CONCLUSIONS The science of digital interventions to support treatment for PEPW is in an early stage, but feasibility and efficacy results are promising. Future research should explore community-based participatory partnerships with PEPW to develop or tailor digital interventions and include family or external support systems to engage in the intervention alongside PEPW.
Collapse
Affiliation(s)
- Phyllis Raynor
- College of Nursing, Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, University of South Carolina, Columbia, SC 29208, USA
| | - Cynthia Corbett
- College of Nursing, Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, University of South Carolina, Columbia, SC 29208, USA
| | - Delia West
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - D’Arion Johnston
- College of Education, University of South Carolina, Columbia, SC 29208, USA
| | - Kacey Eichelberger
- Prisma Health Upstate, University of South Carolina School of Medicine, Greenville, SC 29605, USA
| | - Alain Litwin
- Prisma Health Upstate, University of South Carolina School of Medicine, Greenville, SC 29605, USA
- School of Health Research, Clemson University, Greenville, SC 29601, USA
| | - Constance Guille
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Ron Prinz
- Psychology Department, College of Arts and Sciences, University of South Carolina, Columbia, SC 29208, USA
| |
Collapse
|
25
|
Parlier-Ahmad AB, Eglovitch M, Martin S, Svikis DS, Martin CE. Project BETTER: A Family-Centered, Technology-Delivered Intervention for Pregnant People with Opioid Use Disorder. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020359. [PMID: 36832488 PMCID: PMC9955349 DOI: 10.3390/children10020359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023]
Abstract
Birthing people with opioid use disorder (OUD) face unique stressors during the transition from pregnancy to postpartum that can negatively impact the maternal-infant dyad. This study aimed to describe the development of a family-centered, technology-delivered intervention tailored to help pregnant people receiving medication for OUD (MOUD) prepare for this transition. Formative data from patients and providers identified intervention content: (1) recovery-oriented strategies for the pregnancy-to-postpartum transition; (2) guidance around caring for an infant with opioid withdrawal symptoms; and (3) preparation for child welfare interactions. The content was reviewed in successive rounds by an expert panel and modified. Pregnant and postpartum people receiving MOUD pre-tested the intervention modules and provided feedback in semi-structured interviews. The multidisciplinary expert panel members (n = 15) identified strengths and areas for improvement. Primary areas for improvement included adding content, providing more structure to help participants navigate the intervention more easily, and revising language. Pre-testing participants (n = 9) highlighted four themes: reactions to intervention content, navigability of the intervention, feasibility of the intervention, and recommendation of the intervention. All iterative feedback was incorporated into the final intervention modules for the prospective randomized clinical trial. Family-centered interventions tailored for pregnant people receiving MOUD should be informed by patient-reported needs and multidisciplinary perspectives.
Collapse
Affiliation(s)
- Anna Beth Parlier-Ahmad
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
- Correspondence: ; Tel.: +804-828-8069
| | - Michelle Eglovitch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Sarah Martin
- School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Dace S. Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Caitlin E. Martin
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23298, USA
- Department of Obstetrics and Gynecology, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| |
Collapse
|
26
|
Glass JE, Dorsey CN, Beatty T, Bobb JF, Wong ES, Palazzo L, King D, Mogk J, Stefanik-Guizlo K, Idu A, Key D, Fortney JC, Thomas R, McWethy AG, Caldeiro RM, Bradley KA. Study protocol for a factorial-randomized controlled trial evaluating the implementation, costs, effectiveness, and sustainment of digital therapeutics for substance use disorder in primary care (DIGITS Trial). Implement Sci 2023; 18:3. [PMID: 36726127 PMCID: PMC9893639 DOI: 10.1186/s13012-022-01258-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/22/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Experts recommend that treatment for substance use disorder (SUD) be integrated into primary care. The Digital Therapeutics for Opioids and Other SUD (DIGITS) Trial tests strategies for implementing reSET® and reSET-O®, which are prescription digital therapeutics for SUD and opioid use disorder, respectively, that include the community reinforcement approach, contingency management, and fluency training to reinforce concept mastery. This purpose of this trial is to test whether two implementation strategies improve implementation success (Aim 1) and achieve better population-level cost effectiveness (Aim 2) over a standard implementation approach. METHODS/DESIGN The DIGITS Trial is a hybrid type III cluster-randomized trial. It examines outcomes of implementation strategies, rather than studying clinical outcomes of a digital therapeutic. It includes 22 primary care clinics from a healthcare system in Washington State and patients with unhealthy substance use who visit clinics during an active implementation period (up to one year). Primary care clinics implemented reSET and reSET-O using a multifaceted implementation strategy previously used by clinical leaders to roll-out smartphone apps ("standard implementation" including discrete strategies such as clinician training, electronic health record tools). Clinics were randomized as 21 sites in a 2x2 factorial design to receive up to two added implementation strategies: (1) practice facilitation, and/or (2) health coaching. Outcome data are derived from electronic health records and logs of digital therapeutic usage. Aim 1's primary outcomes include reach of the digital therapeutics to patients and fidelity of patients' use of the digital therapeutics to clinical recommendations. Substance use and engagement in SUD care are additional outcomes. In Aim 2, population-level cost effectiveness analysis will inform the economic benefit of the implementation strategies compared to standard implementation. Implementation is monitored using formative evaluation, and sustainment will be studied for up to one year using qualitative and quantitative research methods. DISCUSSION The DIGITS Trial uses an experimental design to test whether implementation strategies increase and improve the delivery of digital therapeutics for SUDs when embedded in a large healthcare system. It will provide data on the potential benefits and cost-effectiveness of alternative implementation strategies. CLINICALTRIALS gov Identifier: NCT05160233 (Submitted 12/3/2021). https://clinicaltrials.gov/ct2/show/NCT05160233.
Collapse
Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA.
| | - Caitlin N Dorsey
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Edwin S Wong
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, 3980 15th Ave. NE, Fourth Floor, Seattle, WA, 98195, USA
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation, 1660 S Columbian Way, WA, 98108, Seattle, USA
| | - Lorella Palazzo
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Deborah King
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Jessica Mogk
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Kelsey Stefanik-Guizlo
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Abisola Idu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - Dustin Key
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| | - John C Fortney
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation, 1660 S Columbian Way, WA, 98108, Seattle, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Box 356560, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Rosemarie Thomas
- Kaiser Permanente Washington Mental Health & Wellness Services, 1200 SW 27th St, Renton, WA, 98057, USA
| | - Angela Garza McWethy
- Kaiser Permanente Washington Mental Health & Wellness Services, 1200 SW 27th St, Renton, WA, 98057, USA
| | - Ryan M Caldeiro
- Kaiser Permanente Washington Mental Health & Wellness Services, 1200 SW 27th St, Renton, WA, 98057, USA
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA
| |
Collapse
|
27
|
Ono M, Iwasaki K. Comprehensive Analysis of Clinical Studies and Regulations of Therapeutic Applications in the United States and Japan. Ther Innov Regul Sci 2023; 57:86-99. [PMID: 36070067 PMCID: PMC9755089 DOI: 10.1007/s43441-022-00442-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/25/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Digital therapeutics (DTx), the provision of treatment through mobile devices such as smartphones, have attracted great interest as a new medical modality. However, the number of authorized therapeutic applications in the US and Japan is low. Understanding the obstacles in obtaining regulatory authorizations will be the key in promoting timely development of therapeutic applications. Thus, we conducted a comprehensive analysis of the clinical study designs of therapeutic applications authorized in the US and Japan. METHODS Data on authorized therapeutic applications and the regulations involved were collated from the databases of the Food and Drug Administration (USA), Ministry of Health, Labour and Welfare (Japan), and Pharmaceuticals and Medical Devices Agency (Japan). RESULTS Most therapeutic applications authorized targeted neuropsychiatric disorders and used cognitive behavioral therapy (CBT)-based treatments. All the involved clinical trials were randomized-controlled studies. Various types of controls-such as standard care, sham application, digital control, and therapies delivered by healthcare providers-were used. Both subjective and objective indices were acceptable as the primary endpoints. Long-term efficacy was evaluated, and all adverse events were assessed comprehensively. The setting up of controls and the need to study long-term efficacy depend heavily on the applications functionality and the target disease characteristics. CONCLUSIONS This study reveals the points to be considered in planning clinical studies and regulatory strategies for authorizing therapeutic applications. Therapeutic applications can provide new therapy and have potential to solve unmet clinical needs. Our findings shed a light on efficient development and rapid commercialization of therapeutic applications.
Collapse
Affiliation(s)
- Mao Ono
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women’s Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo 162-8480 Japan
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women’s Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo 162-8480 Japan ,Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University, Tokyo, 169-8555 Japan ,Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, 162-8480 Japan ,Institute for Medical Regulatory Science, Waseda University, Tokyo, 162-8480 Japan
| |
Collapse
|
28
|
Xiong X, Braun S, Stitzer M, Luderer H, Shafai G, Hare B, Stevenson M, Maricich Y. Evaluation of real-world outcomes associated with use of a prescription digital therapeutic to treat substance use disorders. Am J Addict 2023; 32:24-31. [PMID: 36264211 PMCID: PMC10091717 DOI: 10.1111/ajad.13346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 08/09/2022] [Accepted: 09/24/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Digital therapeutics can expand the reach and fidelity of behavioral treatment for substance use disorders (SUDs). This analysis evaluated real-world engagement and clinical outcomes in patients diagnosed with SUD who were prescribed reSET®, an FDA-authorized prescription digital therapeutic (PDT). METHODS Patients were prescribed a 12-week PDT comprising 61 therapy lessons (31 "core" and 30 "keep learning" lessons) and contingency management rewards (positive reinforcement message or monetary gift cards) based on lesson completion and negative urine drug screens. Engagement (defined as any activity in the PDT), retention (any activity in Weeks 9-12), and substance use data were collected automatically by the PDT and analyzed descriptively. Associations between early lesson completion and end-of-treatment outcomes were assessed. RESULTS Six hundred and fifty-eight patients filled their prescription. Evaluated were 602 patients who were exposed to therapeutic content by completing at least one lesson (median age 37 years, 33% female, 41% male, 26% unreported sex). Median lessons completed was 33 (out of 61 possible), and 52% of patients completed all core modules. Retention in treatment during the last 4 weeks of treatment was 74%, and 62% were abstinent (missing data considered positive). [Correction added on 13 December 2022, after first online publication: In the preceding sentence, the treatment percentage values were revised from 74.6% to 74%.] DISCUSSION AND CONCLUSIONS: Patients with SUD exhibited robust engagement with a PDT, high rates of retention through 12 weeks, and substantial rates of abstinence at end of treatment when the therapeutic was used in a real-world setting. PDT's hold promise as a new way to access effective SUD treatment. SCIENTIFIC SIGNIFICANCE This study is the first to report real-world PDT engagement and clinical outcomes data from a large, geographically diverse population of patients with SUDs.
Collapse
Affiliation(s)
- Xiaorui Xiong
- Medical Affairs, Pear Therapeutics (US), Boston, Massachusetts, USA
| | - Stephen Braun
- Medical Affairs, Pear Therapeutics (US), Boston, Massachusetts, USA
| | - Maxine Stitzer
- Behavioral Pharmacology Research Unit, Friends Research Institute, Baltimore, Maryland, USA
| | - Hilary Luderer
- Medical Affairs, Pear Therapeutics (US), Boston, Massachusetts, USA
| | - Gigi Shafai
- Medical Affairs, Pear Therapeutics (US), Boston, Massachusetts, USA
| | - Brendan Hare
- Medical Affairs, Pear Therapeutics (US), Boston, Massachusetts, USA
| | | | - Yuri Maricich
- Medical Affairs, Pear Therapeutics (US), Boston, Massachusetts, USA
| |
Collapse
|
29
|
Shams F, Tai AM, Kim J, Boyd M, Meyer M, Kazemi A, Krausz RM. Adherence to e-health interventions for substance use and the factors influencing it: Systematic Review, meta-analysis, and meta-regression. Digit Health 2023; 9:20552076231203876. [PMID: 37780062 PMCID: PMC10540609 DOI: 10.1177/20552076231203876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023] Open
Abstract
Background Substance use disorders affect 36 million people globally, but only a small proportion of them receive the necessary treatment. E-health interventions have been developed to address this issue by improving access to substance use treatment. However, concerns about participant engagement and adherence to these interventions remain. This review aimed to evaluate adherence to e-health interventions targeting substance use and identify hypothesized predictors of adherence. Methods A systematic review of literature published between 2009 and 2020 was conducted, and data on adherence measures and hypothesized predictors were extracted. Meta-analysis and meta-regression were used to analyze the data. The two adherence measures were (a) the mean proportion of modules completed across the intervention groups and (b) the proportion of participants that completed all modules. Four meta-regression models assessed each covariate including guidance, blended treatment, intervention duration and recruitment strategy. Results The overall pooled adherence rate was 0.60 (95%-CI: 0.52-0.67) for the mean proportion of modules completed across 30 intervention arms and 0.47 (95%-CI: 0.35-0.59) for the proportion of participants that completed all modules across 9 intervention arms. Guidance, blended treatment, and recruitment were significant predictors of adherence, while treatment duration was not. Conclusion The study suggests that more research is needed to identify predictors of adherence, in order to determine specific aspects that contribute to better exposure to intervention content. Reporting adherence and predictors in future studies can lead to improved meta-analyses and the development of more engaging interventions. Identifying predictors can aid in designing effective interventions for substance use disorders, with important implications for e-health interventions targeting substance use.
Collapse
Affiliation(s)
- Farhud Shams
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andy M.Y. Tai
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jane Kim
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marisha Boyd
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Maximilian Meyer
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, University of Basel Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Alireza Kazemi
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Reinhard Michael Krausz
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
30
|
Weishaupt I, Mages-Torluoglu J, Kunze C, Weidmann C, Steinhausen K, Bailer AC. Mobile Digital Health Intervention to Promote Nutrition and Physical Activity Behaviors Among Long-term Unemployed in Rural Areas: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e40321. [PMID: 36374540 PMCID: PMC9706377 DOI: 10.2196/40321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Long-term unemployed have poor nutritional and physical activity statuses, and, therefore, special health promotion needs. Particularly in rural areas, however, they often do not have access to health promotion service. Thus, new promising strategies to improve the health of long-term unemployed are needed. Hence, a digital health intervention to promote nutritional and physical health behaviors was conceived, and the effectiveness of the intervention in combination with face-to-face sessions will be evaluated in a randomized controlled trial. OBJECTIVE The aim of this study is to elucidate the effectiveness of a mobile digital health intervention to promote the nutritional and physical activity behaviors of long-term unemployed in the rural areas of Germany. METHODS The 9-week intervention aims to promote nutritional or physical activity behavior by improving drinking habits, increasing the consumption of fruits, vegetables, and whole grains, increasing daily step count, strengthening muscles, and improving endurance. The intervention design is based on the transtheoretical model and is implemented in a mobile app using the MobileCoach open-source platform. The effectiveness of the intervention will be elucidated by a 9-week, 2-armed, parallel-designed trial. Therefore, long-term unemployed will be recruited by employees of the German social sector institutions and randomized either to receive information brochures; the digital intervention in the form of a mobile app; and 3 face-to-face sessions regarding technical support, healthy eating, and physical activity (n=100) or to receive a control treatment consisting of solely the hand over of information brochures (n=100). The effectiveness of the intervention will be assessed using questionnaires at baseline, after 9 weeks in face-to-face appointments, and after a 3-month follow-up period by postal contact. The use of the mobile app will be monitored, and qualitative interviews or focus groups with the participants will be conducted. Incentives of €50 (US $49.7) will be paid to the participants and are tied to the completion of the questionnaires and not to the use of the mobile app or progress in the intervention. RESULTS The effectiveness of the intervention in promoting the nutritional and physical activity behaviors of long-term unemployed participants will be elucidated. The adherence of the participants to and the acceptance and usability of the mobile device app will be evaluated. Recruitment started in March 2022, and the final publication of the results is expected in the first half of 2023. CONCLUSIONS Positive health-related changes made by the intervention would display the potency of digital health interventions to promote nutritional and physical activity behaviors among long-term unemployed in the rural areas of Germany, which would also contribute to an improved health status of the German population in general. TRIAL REGISTRATION German Clinical Trials Register DRKS00024805; https://www.drks.de/DRKS00024805. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/40321.
Collapse
Affiliation(s)
- Iris Weishaupt
- Institute for Applied Health Promotion and Exercise Medicine (IfAG), Faculty of Health, Safety, Society, Furtwangen University, Furtwangen, Germany
- Institute of Sociology, Faculty of Educational Sciences, University of Education Freiburg, Freiburg, Germany
| | - Jennifer Mages-Torluoglu
- Institute for Applied Health Promotion and Exercise Medicine (IfAG), Faculty of Health, Safety, Society, Furtwangen University, Furtwangen, Germany
- University of Applied Sciences Fulda, Fulda, Germany
| | - Christophe Kunze
- Care & Technology Lab (IMTT), Faculty of Health, Safety, Society, Furtwangen University, Furtwangen, Germany
| | - Christian Weidmann
- Institute for Applied Health Promotion and Exercise Medicine (IfAG), Faculty of Health, Safety, Society, Furtwangen University, Furtwangen, Germany
| | - Kirsten Steinhausen
- Institute for Applied Health Promotion and Exercise Medicine (IfAG), Faculty of Health, Safety, Society, Furtwangen University, Furtwangen, Germany
| | - Anja Christina Bailer
- Care & Technology Lab (IMTT), Faculty of Health, Safety, Society, Furtwangen University, Furtwangen, Germany
| |
Collapse
|
31
|
Wu MS, Chen SY, Wickham RE, Leykin Y, Varra A, Chen C, Lungu A. Predicting non-initiation of care and dropout in a blended care CBT intervention: Impact of early digital engagement, sociodemographic, and clinical factors. Digit Health 2022; 8:20552076221133760. [PMID: 36312847 PMCID: PMC9608016 DOI: 10.1177/20552076221133760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
Objective This study examines predictors of non-initiation of care and dropout in a blended care CBT intervention, with a focus on early digital engagement and sociodemographic and clinical factors. Methods This retrospective cohort analysis included 3566 US-based individuals who presented with clinical levels of anxiety and depression and enrolled in a blended-care CBT (BC-CBT) program. The treatment program consisted of face-to-face therapy sessions via videoconference and provider-assigned digital activities that were personalized to the client's presentation. Multinomial logistic regression and Cox proportional hazard survival analysis were used to identify predictors of an increased likelihood of non-initiation of therapy and dropout. Results Individuals were more likely to cancel and/or no-show to their first therapy session if they were female, did not disclose their ethnicity, reported poor financial status, did not have a college degree, endorsed more presenting issues during the onboarding triage assessment, reported taking antidepressants, and had a longer wait time to their first appointment. Of those who started care, clients were significantly more likely to drop out if they did not complete the digital activities assigned by their provider early in treatment, were female, reported more severe depressive symptoms at baseline, reported taking antidepressants, and did not disclose their ethnicity. Conclusions Various sociodemographic and clinical predictors emerged for both non-initiation of care and for dropout, suggesting that clients with these characteristics may benefit from additional attention and support (especially those with poor early digital engagement). Future research areas include targeted mitigation efforts to improve initiation rates and curb dropout.
Collapse
Affiliation(s)
- Monica S. Wu
- Lyra Health, Burlingame, USA
- Monica S. Wu, Lyra Health, 287 Lorton Ave, Burlingame, CA, 94010, USA.
| | | | - Robert E. Wickham
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, USA
- Department of Psychology, Palo Alto University, Palo Alto, USA
| | - Yan Leykin
- Department of Psychology, Palo Alto University, Palo Alto, USA
| | | | | | | |
Collapse
|
32
|
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.
Collapse
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
| | | |
Collapse
|
33
|
Shah N, Velez FF, Colman S, Kauffman L, Ruetsch C, Anastassopoulos K, Maricich Y. Real-World Reductions in Healthcare Resource Utilization over 6 Months in Patients with Substance Use Disorders Treated with a Prescription Digital Therapeutic. Adv Ther 2022; 39:4146-4156. [PMID: 35819569 PMCID: PMC9273919 DOI: 10.1007/s12325-022-02215-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/01/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Substance use disorders (SUDs) affect approximately 40.3 million people in the USA, yet only approximately 19% receive evidence-based treatment each year. reSET® is a prescription digital therapeutic (PDT) and the only FDA-authorized treatment for patients with cocaine, cannabis, and stimulant use disorders. This study evaluated real-world healthcare resource utilization (HCRU) and associated costs 6 months after initiation of reSET in patients with SUD. METHODS A retrospective analysis of HealthVerity PrivateSource20 data compared the 6-month incidence of all-cause hospital facility encounters and clinician services in patients treated with reSET (re-SET cohort) before (pre-index period) and after (post-index period) reSET initiation (index). Incidence was compared using incidence rate ratios (IRR). HCRU-related costs were also assessed. RESULTS The sample included 101 patients (median age 37 years, 50.5% female, 54.5% Medicaid-insured). A statistically significant decrease of 50% was observed in overall hospital encounters from pre-index to post-index (IRR 0.50; 95% CI 0.37-0.67; P < 0.001), which included inpatient stays (56% decrease; IRR 0.44; 95% CI 0.26-0.76; P = 0.003), partial hospitalizations (57% decrease; IRR 0.43; 95% CI 0.21-0.88; P = 0.021), and emergency department visits (45% decrease; IRR 0.55; 95% CI 0.38-0.80; P < 0.004). Additionally, some clinician services declined significantly including pathology and laboratory services: other (54% decrease; IRR 0.46; 95% CI 0.28-0.76; P = 0.003); pathology and laboratory services: drug assays prior to opioid medication prescription (37% decrease; IRR 0.63; 95% CI 0.41-0.96; P = 0.031); and alcohol and drug abuse: medication services (46% decrease; IRR 0.54; 95% CI 0.41-0.70; P < 0.001). Reductions in facility-encounters drove 6-month reSET per-patient cost reductions of $3591 post-index compared to pre-index. CONCLUSIONS Use of reSET by patients with SUD is associated with durable reductions in HCRU and lower healthcare costs over 6 months compared to the 6 months before PDT treatment, after adjusting for covariates, providing an economic benefit to the healthcare system.
Collapse
Affiliation(s)
- Neel Shah
- Pear Therapeutics, Inc. (US), Boston, MA, USA.
| | | | - Samuel Colman
- Market Access Consulting, Labcorp Drug Development, Gaithersburg, MD, USA
| | - Laura Kauffman
- Market Access Consulting, Labcorp Drug Development, Gaithersburg, MD, USA
| | | | | | | |
Collapse
|
34
|
Lutz J, Offidani E, Taraboanta L, Lakhan SE, Campellone TR. Appropriate controls for digital therapeutic clinical trials: A narrative review of control conditions in clinical trials of digital therapeutics (DTx) deploying psychosocial, cognitive, or behavioral content. Front Digit Health 2022; 4:823977. [PMID: 36060538 PMCID: PMC9436387 DOI: 10.3389/fdgth.2022.823977] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Digital therapeutics (DTx) are software programs that treat a disease or condition. Increasingly, DTx are part of medical care, and in the US healthcare system they are regulated by the FDA as Software as a Medical Device (SaMD). Randomized controlled trials (RCT) remain a key evidence generation step for most DTx. However, developing a unified approach to the design of appropriate control conditions has been a challenge for two main reasons: (1) inheriting control condition definitions from pharmacotherapy and medical device RCT that may not directly apply, and (2) challenges in establishing control conditions for psychosocial interventions that build the core of many DTx. In our critical review we summarize different approaches to control conditions and patient blinding in RCT evaluating DTx with psychosocial, cognitive or behavioral content. We identify control condition choices, ranging from very minimal digital controls to more complex and stringent digital applications that contain aspects of “fake” therapy, general wellness content or games. Our review of RCTs reveals room for improvement in describing and naming control conditions more consistently. We further discuss challenges in defining placebo controls for DTx and ways in which control choices may have a therapeutic effect. While no one-size-fits-all control conditions and study designs will apply to all DTx, we propose points to consider for defining appropriate digital control conditions. At the same time, given the rapid iterative development and optimization of DTx, treatments with low risk profile may be evaluated with minimal digital controls followed by extensive real-world effectiveness trials.
Collapse
Affiliation(s)
- Jacqueline Lutz
- Medical Office, Click Therapeutics Inc., New York, NY, United States
| | - Emanuela Offidani
- Medical Office, Click Therapeutics Inc., New York, NY, United States
- Clinical Epidemiology Research in Medicine, Weill Cornell Medicine, New York, United States
| | - Laura Taraboanta
- Medical Office, Click Therapeutics Inc., New York, NY, United States
| | - Shaheen E. Lakhan
- Medical Office, Click Therapeutics Inc., New York, NY, United States
- School of Neuroscience, Virginia Tech, Blacksburg, VA, United States
- Correspondence: Shaheen E. Lakhan
| | | |
Collapse
|
35
|
Huh KY, Oh J, Lee S, Yu KS. Clinical Evaluation of Digital Therapeutics: Present and Future. Healthc Inform Res 2022; 28:188-197. [PMID: 35982593 PMCID: PMC9388922 DOI: 10.4258/hir.2022.28.3.188] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/14/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives Digital therapeutics (DTx) are software-based therapeutic interventions based on clinical evidence. Randomized clinical trials (RCTs) are often the source of clinical evidence, similar to conventional drugs or medical devices. However, novel approaches such as the use of real-world data or digital biomarkers are also utilized. This article aimed to review how DTx products have been clinically evaluated. Methods DTx products approved by the US Food and Drug Administration as of 2020 were reviewed and products with sufficient published information were selected. Pivotal clinical trials were analyzed according to the elements of the Consolidated Standards of Reporting Trials (CONSORT) guideline. Case reviews were presented for other clinical evaluation strategies, considering the small number of publications. Results Most approved DTx products used RCTs for clinical evaluations. Similar to conventional RCTs, parallel-group designs with statistical hypothesis testing were adopted. However, DTx trials were often not blinded due to practical issues and involved various comparator groups. In addition, DTx products could be readily evaluated in home-based settings and delivered through the internet. Other evaluation approaches included retrospective analyses using insurance claims data or usage data, which enabled long-term evaluations of effectiveness. Digital biomarkers obtained from real-time and continuous log data were also used to improve the objectiveness of endpoints. Conclusions RCTs accounted for the majority of DTx evaluations. The designs of DTx trials were comparable to those of drug or device trials, but blinding and comparator elements were often different. Furthermore, the use of real-world data and digital biomarkers are also being tried.
Collapse
Affiliation(s)
- Ki Young Huh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Jaeseong Oh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| |
Collapse
|
36
|
Contingency management and cognitive behavior therapy for smoking cessation among veterans with posttraumatic stress disorder: Design and methodology of a randomized clinical trial. Contemp Clin Trials 2022; 119:106839. [PMID: 35760338 PMCID: PMC9420819 DOI: 10.1016/j.cct.2022.106839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Smoking is a prevalent concern among Veterans, especially those with posttraumatic stress disorder (PTSD). Despite the availability of interventions for smoking cessation, these treatments have not been as effective among Veteran populations, particularly Veterans with PTSD. The present study seeks to describe the methods of a randomized clinical trial examining the efficacy of CPT-SMART, a multidimensional treatment combining cognitive processing therapy (CPT) for PTSD, smoking cessation counseling, pharmacotherapy, and contingency management (CM) compared to a yoked comparison group. METHODS One hundred twenty Veterans with PTSD who smoke cigarettes will be enrolled. All participants will receive CPT in addition to counseling and pharmacotherapy for smoking cessation. Participants will be randomized to the CPT-SMART condition, which includes monetary reinforcement that is contingent on bioverification of smoking abstinence (i.e., contingency management), or a yoked comparison with monetary reinforcement matched to the participant to whom they are yoked. The primary outcome is bioverified smoking abstinence at the 6-month follow-up appointment. CONCLUSION If shown efficacious, a combined PTSD and smoking treatment plus incentive-based approach for smoking could be implemented into specialty PTSD programs. The positive public health impact of reducing smoking among Veterans with PTSD could be enormous as it would prevent significant smoking-related morbidity and mortality.
Collapse
|
37
|
Abstract
In recent decades, the United States has seen a substantial increase in the number of people diagnosed with substance use disorder (SUD). Both SUDs and COVID-19 separately have had, and continue to have, a widespread impact on our society. While they are two distinct entities, they are intricately related and have been shown to influence one another. Lockdown mandates intended to enhance public safety produced unintended consequences for people with SUDs by decreasing access to treatment and disrupting their current care. Telehealth could offer a solution to this disruption as its utilization expands the provider’s reach and increases access to treatment in underserved populations, including those with SUDs. The use of telemedicine seems to result in higher rates of patient satisfaction, compliance, and treatment retention rates while maintaining the need for social distancing. Even when pandemic restrictions resolve, telehealth can continue to provide invaluable benefits to individuals with addiction, particularly those in rural America. In summary, ongoing research regarding telehealth delivery and the expansion of telehealth is a byproduct of the pandemic and can advance the American healthcare system beyond the days of COVID-19. This manuscript will review studies regarding the use of telehealth in SUD with the hope that further research within and beyond the COVID-19 pandemic will lead to the increased use of telehealth by those involved in and those receiving care for SUDs.
Collapse
|
38
|
Tarp K, Rasmussen J, Mejldal A, Folker MP, Nielsen AS. Blended Treatment for Alcohol Use Disorder (Blend-A): Explorative Mixed Methods Pilot and Feasibility Study. JMIR Form Res 2022; 6:e17761. [PMID: 35468082 PMCID: PMC9086873 DOI: 10.2196/17761] [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: 01/13/2020] [Revised: 05/05/2020] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background In Denmark, approximately 150,000 people have alcohol use disorder (AUD). However, only approximately 10% seek AUD treatment, preferably outside conventional health care settings and opening hours. The AUD treatment area experiences low adherence to treatment, as well as high numbers of no-show and premature dropouts. Objective The purpose of the Blend-A (Blended Treatment for Alcohol Use Disorder) feasibility and pilot study was to describe the process of translating and adapting the Dutch treatment protocol into Danish and Danish culture with a high amount of user involvement and to report how patients and therapists perceived the adapted version, when trying it out. Methods The settings were 3 Danish public municipal outpatient alcohol clinics. Study participants were patients and therapists from the 3 settings. Data consisted of survey data from the System Usability Scale, individual patient interviews, and therapist group interviews. Statistical analyses were conducted using the Stata software and Excel. Qualitative analysis was conducted using a theoretical thematic analysis. Results The usability of the treatment platform was rated above average. The patients chose to use the blended treatment format because it ensured anonymity and had a flexible design. Platform use formed the basis of face-to-face sessions. The use of the self-determined platform resulted in a more thorough process. Patient involvement qualified development of a feasible system. Managerial support for time use was essential. Guidance from an experienced peer was useful. Conclusions This study indicates that, during the processes of translating, adapting, and implementing blended, guided, internet-based, and face-to-face AUD treatment, it is relevant to focus on patient involvement, managerial support, and guidance from experienced peers. Owing to the discrete and flexible design of the blended offer, it appears that it may reach patient groups who would not otherwise have sought treatment. Therefore, blended treatment may increase access to treatment and contribute to reaching people affected by excessive alcohol use, who would not otherwise have sought treatment. In addition, it seems that the blended offer may enhance the participants’ perceived satisfaction and the effect of the treatment course. Thus, it appears that Blend-A may be able to contribute to existing treatment offers. Such findings highlight the need to determine the actual effect of the Blend-A offer; therefore, an effectiveness study with a controlled design is warranted.
Collapse
Affiliation(s)
- Kristine Tarp
- Centre for Telepsychiatry, Mental Health Services, Region of Southern Denmark, Odense, Denmark.,Research Unit for Telepsychiatry and E-mental Health, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Anna Mejldal
- Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN Odense Patient data Explorative Network, Odense, Denmark
| | - Marie Paldam Folker
- Centre for Telepsychiatry, Mental Health Services, Region of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Psychiatry, Mental Health Services, Region of Southern Denmark, Odense, Denmark.,BRIDGE, Brain Research - Inter-Disciplinary Guided Excellence, Odense, Denmark
| |
Collapse
|
39
|
Maricich YA, Nunes EV, Campbell ANC, Botbyl JD, Luderer HF. Safety and efficacy of a digital therapeutic for substance use disorder: Secondary analysis of data from a NIDA clinical trials network study. Subst Abus 2022; 43:937-942. [PMID: 35420979 DOI: 10.1080/08897077.2022.2060425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Traditional treatments for substance use disorders (SUDs) rely heavily on face-to-face interactions, which pose substantial limitations for patients. A clinical trial of a digital therapeutic (DT), delivering behavioral therapy demonstrated safety and efficacy in a population including patients with opioid use disorder (OUD) not treated with buprenorphine, which is not a guideline-recommended approach. This study re-analyzed the data excluding patients with OUD to more closely approximate real-world patient populations. Methods: Secondary analysis of patients with substance use disorders related to alcohol, cannabis, cocaine, or other stimulants (n = 399, patients with OUD excluded) from a previously-published randomized controlled trial. Patients received 12-weeks of outpatient treatment-as-usual (TAU; n = 193) or TAU with reduced counseling plus a DT (n = 206) providing computerized cognitive behavioral therapy and contingency management. Primary outcomes were abstinence in weeks 9-12 and retention in treatment. Results: The 399 patients in this analysis (206 in the DT group and 193 in the TAU group) reported substance use disorders related to alcohol, cannabis, cocaine, or other stimulants (e.g., methamphetamines). Demographic and baseline characteristics including age, sex, race, education, and reported primary substance use disorder were balanced between treatment groups. Abstinence was significantly higher in the DT group compared to TAU (40.3 vs. 17.6%; p < 0.001) as was retention in therapy (76.2 vs. 63.2%, p = 0.004). Intergroup adverse event rates were not significantly different (p = 0.68). Conclusions: The results demonstrate that use of a DT safely increased abstinence (reduced substance use) and retention in treatment among patients with substance use disorders related to alcohol, cannabis, cocaine, or other stimulants (including methamphetamines).
Collapse
Affiliation(s)
| | - Edward V Nunes
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA
| | - Aimee N C Campbell
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA
| | | | | |
Collapse
|
40
|
Schlieter H, Marsch LA, Whitehouse D, Otto L, Londral AR, Teepe GW, Benedict M, Ollier J, Ulmer T, Gasser N, Ultsch S, Wollschlaeger B, Kowatsch T. Scale-up of Digital Innovations in Health Care: Expert Commentary on Enablers and Barriers. J Med Internet Res 2022; 24:e24582. [PMID: 35275065 PMCID: PMC8956989 DOI: 10.2196/24582] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/17/2021] [Accepted: 12/28/2021] [Indexed: 12/13/2022] Open
Abstract
Health care delivery is undergoing a rapid change from traditional processes toward the use of digital health interventions and personalized medicine. This movement has been accelerated by the COVID-19 crisis as a response to the need to guarantee access to health care services while reducing the risk of contagion. Digital health scale-up is now also vital to achieve population-wide impact: it will only accomplish sustainable effects if and when deployed into regular health care delivery services. The question of how sustainable digital health scale-up can be successfully achieved has, however, not yet been sufficiently resolved. This paper identifies and discusses enablers and barriers for scaling up digital health innovations. The results discussed in this paper were gathered by scientists and representatives of public bodies as well as patient organizations at an international workshop on scaling up digital health innovations. Results are explored in the context of prior research and implications for future work in achieving large-scale implementations that will benefit the population as a whole.
Collapse
Affiliation(s)
- Hannes Schlieter
- Research Group Digital Health, Faculty of Business and Economics, Technische Universität Dresden, Dresden, Germany
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | - Lena Otto
- Research Group Digital Health, Faculty of Business and Economics, Technische Universität Dresden, Dresden, Germany
| | - Ana Rita Londral
- Value for Health CoLAB, NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal.,Comprehensive Health Research Center, NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Gisbert Wilhelm Teepe
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Martin Benedict
- Research Group Digital Health, Faculty of Business and Economics, Technische Universität Dresden, Dresden, Germany
| | - Joseph Ollier
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Tom Ulmer
- Institute of Information and Process Management, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | | | - Sabine Ultsch
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Bastian Wollschlaeger
- Research Group Digital Health, Faculty of Business and Economics, Technische Universität Dresden, Dresden, Germany
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland.,Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
41
|
Marsch LA, Gómez-Restrepo C, Bartels SM, Bell K, Camblor PM, Castro S, Cárdenas Charry MP, Cepeda M, Cubillos L, John D, Jassir MP, Lemley SM, Suárez-Obando F, Torrey WC, Uribe JM, Williams MJ. Scaling Up Science-Based Care for Depression and Unhealthy Alcohol Use in Colombia: An Implementation Science Project. Psychiatr Serv 2022; 73:196-205. [PMID: 34347504 PMCID: PMC8810677 DOI: 10.1176/appi.ps.202000041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mental disorders are a major cause of the global burden of disease and significantly contribute to disability and death. This challenge is particularly evident in low- and middle-income countries (LMICs), where >85% of the world's population live. Latin America is one region comprising LMICs where the burden of mental disorders is high and the availability of mental health services is low. This is particularly evident in Colombia, a country with a long-standing history of violence and associated mental health problems. METHODS This article describes the design of a multisite implementation science project, "Scaling Up Science-Based Mental Health Interventions in Latin America" (also known as the DIADA project), that is being conducted in six primary care systems in Colombia. This project, funded via a cooperative agreement from the National Institute of Mental Health, seeks to implement and assess the impact of a new model for promoting widespread access to mental health care for depression and unhealthy alcohol use within primary care settings and building an infrastructure to support research capacity and sustainability of the new service delivery model in Colombia. This care model centrally harnesses mobile health technology to increase the reach of science-based mental health care for depression and unhealthy alcohol use. RESULTS This initiative offers great promise to increase capacity for providing and sustaining evidence-based treatment for depression and unhealthy alcohol use in Colombia. NEXT STEPS This project may inform models of care that can extend to other regions of Latin America or other LMICs.
Collapse
Affiliation(s)
- Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Carlos Gómez-Restrepo
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Sophie M Bartels
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Kathleen Bell
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Pablo Martinez Camblor
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Sergio Castro
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Maria Paula Cárdenas Charry
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Magda Cepeda
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Deepak John
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Maria Paula Jassir
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Shea M Lemley
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Fernando Suárez-Obando
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - William C Torrey
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - José Miguel Uribe
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| | - Makeda J Williams
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams)
| |
Collapse
|
42
|
Eysenbach G, Chiodo L, Wilson A, Brezing C, Martinez S, Xiong X, Gerwien R, Imbert B, Deeg M, Maricich Y, Campbell A. Patient Engagement With a Game-Based Digital Therapeutic for the Treatment of Opioid Use Disorder: Protocol for a Randomized Controlled Open-Label, Decentralized Trial. JMIR Res Protoc 2022; 11:e32759. [PMID: 35080499 PMCID: PMC8829697 DOI: 10.2196/32759] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Prescription digital therapeutics are software-based disease treatments that are regulated by the US Food and Drug Administration; the reSET-O prescription digital therapeutic was authorized in 2018 and delivers behavioral treatment for individuals receiving buprenorphine for opioid use disorder. Although reSET-O improves outcomes for individuals with opioid use disorder, most of the therapeutic content is delivered as narrative text. PEAR-008 is an investigational device based on reSET-O that uses an interactive, game-based platform to deliver similar therapeutic content designed to enhance patient engagement, which may further improve treatment outcomes. OBJECTIVE We aim to investigate how participants interact with the prescription digital therapeutic's new content delivery format. Secondary objectives include evaluating treatment success, symptoms of co-occurring mental health disorders, recovery capital, and skill development. METHODS Due to the COVID-19 pandemic, this study was redesigned using a decentralized model because it was not possible to conduct medication initiation and study visits in person, as initially intended. A decentralized, randomized controlled trial design will be utilized to compare patient engagement with PEAR-008 and that with reSET-O using both subjective and objective assessments. The study population will consist of approximately 130 individuals with opioid use disorder (based on Diagnostic and Statistical Manual of Mental Disorders 5 criteria) who have recently started buprenorphine treatment for opioid use disorder. Participants will be virtually recruited and randomly assigned to receive either PEAR-008 or reSET-O. All study sessions will be virtual, and the duration of the study is 12 weeks. The primary outcome measure of engagement is operationalized as the number of active sessions per week with either PEAR-008 or reSET-O. (An active session is any session that contains some active participation in the app, such as navigating to a different screen, engaging with a learning module, or responding to a notification.) Subjective dimensions of engagement will be assessed with participant surveys. The hypothesis is that PEAR-008 will have significantly greater participant engagement than reSET-O. RESULTS As of February 2021, participant enrollment is ongoing. CONCLUSIONS This randomized controlled trial will investigate if changing the delivery format and enhancing the content of a prescription digital therapeutic for opioid use disorder will affect how participants use and interact with the prescription digital therapeutic. The study design may serve as a useful model for conducting decentralized studies in this patient population. TRIAL REGISTRATION ClinicalTrials.gov NCT04542642; https://clinicaltrials.gov/ct2/show/NCT04542642. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32759.
Collapse
Affiliation(s)
| | - Lisa Chiodo
- Addiction Research and Education Foundation/Clean Slate, Florence, MA, United States
| | - Amanda Wilson
- Addiction Research and Education Foundation/Clean Slate, Florence, MA, United States
| | | | | | | | | | - Bruce Imbert
- Pear Therapeutics, Inc, Boston, MA, United States
| | - Mark Deeg
- Pear Therapeutics, Inc, Boston, MA, United States
| | | | | |
Collapse
|
43
|
Kim SY, Moon JY, Shin J, Sim JY, Kim M, Jang J. Survey for Government Policies Regarding Strategies for the Commercialization and Globalization of Digital Therapeutics. Yonsei Med J 2022; 63:S56-S62. [PMID: 35040606 PMCID: PMC8790580 DOI: 10.3349/ymj.2022.63.s56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study was conducted to build a direction for government policies regarding strategies for the commercialization of digital therapeutics in Korea, as well as its globalization. MATERIALS AND METHODS The study included 37 participants from the Korea Digital Health Industry Association (KODHIA). The data was based on a survey conducted in 2020 targeting employees of companies engaged in the digital health industry in Korea. Participants were asked about their involvement in product development of digital therapeutics and their opinion about the growing motivator for digital therapeutics in Korea and the global market. RESULTS According to our data, among subjects not involved in making digital therapeutics products, the main reason for not being involved was the lack of experts (73.9%) and difficulty in licensing (73.9%). Responses concerning the priority area in need of national support were R&D funding (43.2%), and the next was licensing guidance and simplifying regulations (24.3%). Possible difficulties of overseas market expansion were the unfamiliarity in digital therapeutics technology verification and licensing structures of foreign countries (73%), and concerns regarding the level of recognition of clinical trials and technology in Korea from overseas (70.3%). Overall, respondents were hesitant in starting a related business due to the lack of government support and the complexity of the regulation process. Moreover, concerns about global market entry were similar. Being unfamiliar with the novel process and worrying about the achievement despite existing challenges were the biggest drawback. CONCLUSION For the digital therapeutics industry to evolve domestically and internationally, government support and guidance are essential.
Collapse
Affiliation(s)
- Soo Young Kim
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Jong Youn Moon
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
- Center for Public Healthcare, Gachon University Gil Medical Center, Incheon, Korea.
| | - Jaeyong Shin
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Jung Yeon Sim
- Department of Medical Device Engineering and Management, Yonsei University Graduate School, Seoul, Korea
| | - Meelim Kim
- Health IT Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jieun Jang
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| |
Collapse
|
44
|
Brezing CA, Brixner DI. The Rise of Prescription Digital Therapeutics in Behavioral Health. Adv Ther 2022; 39:5301-5306. [PMID: 36242730 PMCID: PMC9569000 DOI: 10.1007/s12325-022-02320-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/07/2022] [Indexed: 01/30/2023]
Abstract
Medicine is evolving to incorporate digital technologies of all kinds-technologies that may improve patient health, reduce clinician workload, lower costs, reduce health disparities, and expand access to needed treatments. Prescription digital therapeutics (PDTs) are an emerging technology with particular potential. These are software-based treatments delivered on mobile devices that address the behavioral dimensions of many diseases and conditions. Unlike health and wellness apps, PDTs are rigorously evaluated for safety and effectiveness and are authorized by the US Food and Drug Administration (FDA). Nine PDTs are currently authorized to treat conditions such as substance use disorders, attention-deficit disorder, and chronic insomnia. The findings reported in two recent research papers published by Advances in Therapy related to use of PDTs for substance use disorder and opioid use disorder provide real-world evidence of clinical and cost effectiveness, strengthening the evidence base for these technologies and suggesting a role for these technologies in the efforts to help patients recover from these often-chronic and deadly conditions.
Collapse
Affiliation(s)
- Christina A. Brezing
- grid.21729.3f0000000419368729Department of Psychiatry, Columbia University, New York, NY USA
| | - Diana I. Brixner
- grid.223827.e0000 0001 2193 0096University of Utah College of Pharmacy, Salt Lake City, UT USA
| |
Collapse
|
45
|
Velez FF, Anastassopoulos KP, Colman S, Shah N, Kauffman L, Murphy SM, Ruetsch C, Maricich YA. Reduced Healthcare Resource Utilization in Patients with Opioid Use Disorder in the 12 Months After Initiation of a Prescription Digital Therapeutic. Adv Ther 2022; 39:4131-4145. [PMID: 35799080 PMCID: PMC9402736 DOI: 10.1007/s12325-022-02217-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/07/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS reSET-O, an FDA-authorized prescription digital therapeutic (PDT) delivering cognitive behavioral therapy and contingency management to patients with opioid u®se disorder (OUD), may help improve clinical outcomes. One-year differences in healthcare resource utilization (HCRU) and costs post-PDT initiation were evaluated. METHODS Retrospective analysis of healthcare claims data compared all-cause HCRU (across hospital facility encounters [sum of inpatient stays, treat-and-release emergency department [ED] visits, partial hospitalizations, and hospital outpatient department visits] and clinician services [procedure categories]) after PDT initiation (index) between reSET-O patients and controls. Overall and Medicaid-specific differences in HCRU, costs, and buprenorphine adherence were evaluated. FINDINGS Cohorts included 901 reSET-O patients (median age 36 years, 62.4% female, 73.9% Medicaid) and 978 controls (median age 38 years, 51.1% female, 65.4% Medicaid). Compared to the control group, the reSET-O group experienced 12% fewer total unique hospital encounters (non-significant), driven by 28% fewer inpatient stays (IRR 0.72; 95% CI 0.55-0.96; P = 0.02), 56% fewer hospital readmissions [IRR 0.44; 95% CI 0.20-0.93; P = 0.033]), and 7% fewer ED visits (IRR 0.93; 95% CI 0.79-1.09; P = 0.386). Total clinician services increased by 1391 events versus controls. Differences were greater among the Medicaid patients. Adjustment for concomitant baseline substance use and mental health disorders resulted in similar HCRU incidence rate ratios. Changes in all-cause HCRU drove per-patient per-year cost differences of - $2791 versus controls (- $3832 versus Medicaid controls). Adjusted mean medication possession ratio was 0.848 (SE 0.0118) at 12 months for reSET-O patients, which was significantly higher than controls (0.761 [SE 0.0108]; P < 0.001). CONCLUSIONS Use of reSET-O is associated with significant and durable real-world reductions in ED and inpatient (including readmissions) utilization, reduced net costs, and increased clinician services and buprenorphine adherence. Differences in costs versus controls were greatest among Medicaid patients. INFOGRAPHIC.
Collapse
Affiliation(s)
- Fulton F. Velez
- Pear Therapeutics (US), Inc., 200 State St., Boston, MA 02109 USA
| | | | - Samuel Colman
- Market Access Consulting, Labcorp Drug Development, Gaithersburg, MD USA
| | - Neel Shah
- Pear Therapeutics (US), Inc., 200 State St., Boston, MA 02109 USA
| | - Laura Kauffman
- Market Access Consulting, Labcorp Drug Development, Gaithersburg, MD USA
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY USA
| | | | - Yuri A. Maricich
- Pear Therapeutics (US), Inc., 200 State St., Boston, MA 02109 USA
| |
Collapse
|
46
|
Schulte MH, Boumparis N, Huizink AC, Riper H. Technological Interventions for the Treatment of Substance Use Disorders. COMPREHENSIVE CLINICAL PSYCHOLOGY 2022. [PMCID: PMC7500918 DOI: 10.1016/b978-0-12-818697-8.00010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Substance use disorders (SUDs) pose a major public health concern. In recent years, technological (i.e., e-health) interventions have emerged and are increasingly offered in a variety of settings, including substance use treatment. E-health interventions encompass a wide variety of advantages depending on the chosen delivery format. This chapter discusses existing interventions and the effectiveness of delivering them as an e-health intervention, with a focus on randomized controlled trials, for the treatment of alcohol, cannabis, opioid, psychostimulant, or poly-substance use, as well as in transdiagnostic interventions. Based on the literature, suggestions for future research and clinical implications are discussed.
Collapse
|
47
|
Zhang L, Li N, Li Y, Zhang T, Li D, Liu Y, Liu X, Hao W. Preliminary efficacy of a digital therapeutics smartphone application for methamphetamine use disorder: An experimental study. Front Psychiatry 2022; 13:1027695. [PMID: 36339836 PMCID: PMC9627209 DOI: 10.3389/fpsyt.2022.1027695] [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: 08/25/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Methamphetamine is the most widely used illicit drug in China. Treating methamphetamine use disorder (MUD) is challenging due to the lack of effective pharmacotherapies. This study is an experimental study to investigate the efficacy of smartphone-based digital therapeutics in treating MUD at the community level. One hundred participants were recruited and randomized into a digital therapeutics (DTx) group (n = 52) and a treatment as usual (TAU) group (n = 48). The DTx group used a smartphone application to deliver cognitive behavioral therapy, approach bias modification, cognitive training, and contingency management for 8 weeks. The TAU group received counseling from social workers and professional psychotherapists. Cue-induced craving, cognitive functions, PHQ9, and GAD7 were measured at baseline and post-intervention. Wilcoxon tests were performed with bootstrap and multiply imputation to estimate the treatment effect size. The DTx group showed a significant reduction in drug craving [Wilcoxon effect size = -0.267, 95% CI = (-0.435, -0.099), p = 0.002] and a significant improvement in cognitive function [Wilcoxon effect size = 0.220, 95% CI = (0.009, 0.432), p = 0.041]. The DTx group had overall 1, 8, and 24-week attritions of 8%, 11.5%, and 38.5%, respectively. The study shows that Digital therapeutics is feasible and potentially beneficial as a complement to community substance use treatment programs.
Collapse
Affiliation(s)
- Liqun Zhang
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | - Nan Li
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Yuanhui Li
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | | | - Dai Li
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | - Yanru Liu
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | - Xiang Liu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Wei Hao
- National Clinical Research Center on Mental Disorders, Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
48
|
Glass JE, Tiffany B, Matson TE, Lim C, Gundersen G, Kimbel K, Hartzler AL, Curran GM, McWethy AG, Caldeiro RM, Bradley KA. Approaches for implementing digital interventions for alcohol use disorders in primary care: A qualitative, user-centered design study. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221135264. [PMID: 37091101 PMCID: PMC9924279 DOI: 10.1177/26334895221135264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Digital interventions, such as smartphone apps, can be effective in treating alcohol use disorders (AUD). However, efforts to integrate digital interventions into primary care have been challenging. To inform successful implementation, we sought to understand how patients and clinicians preferred to use apps in routine primary care. Methods This study combined user-centered design and qualitative research methods, interviewing 18 primary care patients with AUD and nine primary care clinicians on topics such as prior experiences with digital tools, and design preferences regarding approaches for offering apps for AUD in primary care. Interviews were recorded and transcribed for template analysis whereby a priori codes were based on interview topics and refined through iterative coding. New codes and cross-cutting themes emerged from the data. Results Patient participants with AUD indicated they would be more likely to engage in treatment if primary care team members were involved in their use of apps. They also preferred to see clinicians “invested” and recommended that clinicians ask about app use and progress during follow-up appointments or check-ins. Clinician participants valued the opportunity to offer apps to their patients but noted that workflows would need to be tailored to individual patient needs. Time pressures, implementation complexity, and lack of appropriate staffing were cited as barriers. Clinicians proposed concrete solutions (e.g., education, tools, and staffing models) that could improve their ability to use apps within the constraints of primary care and suggested that some patients could potentially use apps without clinician support. Conclusions A user-centered approach to engaging patients in digital alcohol interventions in primary care may require personalized support for both initiation and follow-up. Meeting patients’ needs likely require increased staffing and efficient workflows in primary care. Health systems should consider offering multiple pathways for enrolling patients in apps to accommodate individual preferences and contextual barriers. Plain Language Summary Healthcare systems have begun using app-based treatments to help patients manage their health conditions, including alcohol use disorders. Some apps have been tested in research studies and appear to be effective. However, it is difficult for healthcare teams to offer apps to patients. Clinicians must engage in new activities that they have not done before, such as “teaching” patients to use apps and checking in on their use of the apps. Identifying how to use apps in routine healthcare is critical to their successful implementation. This study interviewed 27 people, including healthcare providers and patients in primary care, to uncover the most optimal ways to offer apps to patients with alcohol use disorders. The interviews combined the use of qualitative research methods and user-centered design. Results suggest that to use to address alcohol use disorders, primary care teams should be prepared to offer personalized support to patients. Both patient and clinician interviewees said that the steps required to use apps must be intuitive and simple. Patients could gain more benefits if clinicians introduced the apps and guided patients to use them, as opposed to making apps available for patients to download and use on their own. However, the exact approach to offering apps would depend on a given patient’s preferences and the extent that staffing was available in the clinic to support patients. Health systems should be prepared to offer and support patients in their use of apps, which should accommodate patient preferences and the constraints of the clinic.
Collapse
Affiliation(s)
- Joseph E. Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Brooks Tiffany
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Catherine Lim
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Kilian Kimbel
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Andrea L. Hartzler
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
| | - Geoffrey M. Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | | | - Ryan M. Caldeiro
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, USA
| | | |
Collapse
|
49
|
Brezing CA, Levin FR. Applications of technology in the assessment and treatment of cannabis use disorder. Front Psychiatry 2022; 13:1035345. [PMID: 36339845 PMCID: PMC9626500 DOI: 10.3389/fpsyt.2022.1035345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022] Open
Abstract
Cannabis use and Cannabis Use Disorder (CUD) have been increasing. There are no FDA approved medications and evidence-based psychotherapy is limited by insufficient providers, serving very few patients effectively. The lack of resources for prevention and treatment of CUD has resulted in a significant gap between the need for services and access to treatment. The creation of a scalable system to prevent, screen, refer and provide treatment for a chronic, relapsing diagnosis like CUD could be achieved through the application of technology. Many studies have utilized ecological momentary assessments (EMA) in treatment seeking and non-treatment seeking cannabis users. EMA allows for repeated, intensive, longitudinal data collection in vivo. EMA has been studied in cannabis use and its association with affect, craving, withdrawal, other substances, impulsivity, and interpersonal behaviors. EMA has the potential to serve as a valuable monitoring tool in prevention, screening, and treatment for CUD. Research has also focused on the development of internet and application-based treatments for CUD, including a currently available prescription digital therapeutic. Treatment options have expanded to more broadly incorporate telehealth as an option for CUD treatment with broad acceptance and change in regulation following the COVID-19 pandemic. While technology has limitations, including cost, privacy concerns, and issues with engagement, it will be a necessary medium to meet societal health needs as a consequence of an ever-changing cannabis regulatory landscape. Future work should focus on improving existing platforms while ethically incorporating other functions (e.g., sensors) to optimize a public and clinical health approach to CUD.
Collapse
Affiliation(s)
- Christina A Brezing
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Frances R Levin
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| |
Collapse
|
50
|
Nwosu A, Boardman S, Husain MM, Doraiswamy PM. Digital therapeutics for mental health: Is attrition the Achilles heel? Front Psychiatry 2022; 13:900615. [PMID: 35982936 PMCID: PMC9380224 DOI: 10.3389/fpsyt.2022.900615] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adaora Nwosu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Samantha Boardman
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States
| | - Mustafa M Husain
- Departments of Psychiatry, Neurology and Biomedical Engineering, Southwestern Medical Center, The University of Texas, Austin, TX, United States
| | - P Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Duke Institute for Brain Sciences, Duke University, Durham, NC, United States
| |
Collapse
|