Efforts are underway to spur much-needed change in how health systems provide high quality, evidence-based, comprehensive care for patients living with substance use disorders. As with all areas of healthcare, telemedicine and mobile technology are rapidly emerging as ways to facilitate addiction treatment.
Technology-based approach to buprenorphine treatment
In a study funded by the National Institute on Drug Abuse (NIDA), emocha is working with clinicians and researchers at the University of Washington and Boston Medical Centers to better understand patients’ and providers’ views of mobile technology for treating opioid use disorder. University of Washington Associate Professor of Medicine Dr. Judith Tsui presented this work, Perspectives on Buprenorphine Adherence and Use of mHealth Technology to Address Barriers, at this year’s American Society for Addiction Medicine (ASAM) conference in San Diego.
For the study, patients and providers participated in semi-structured interviews and focus group discussions on the topic of medication adherence and the role of mobile technology. The study was done at an urban, academic medical center’s office-based buprenorphine treatment (OBOT) program within an adult primary care clinic to explore attitudes related to buprenorphine adherence.
Researchers asked patients and providers about one intervention to secure medication adherence in particular: asynchronous video Directly Observed Therapy, or DOT. DOT is the practice of watching patients take every dose of medication and supporting them throughout treatment. emocha scales this practice using mobile technology; patients use a smartphone application to record videos of themselves taking each dose of medication and report any associated side effects. Providers assess this data using a secure web portal and engage with patients as needed.
Participants highlighted several barriers to buprenorphine adherence, such as insecure housing, transportation, and forgetfulness, among others. When asked about video DOT, patients and providers both believed the technology would be helpful for patients beginning treatment to establish trust and transparency.
In partnership with NIDA, emocha is conducting a follow-up study with the University of Washington to examine the acceptability and feasibility of patients in an OBOT program using video DOT for each dose of buprenorphine. Results of this study will serve as an ideal complement to this qualitative data to inform user-centered design of the technology to increase care retention and health outcomes.
Patient-centric substance use disorder treatment
Dr. Tsui’s research was one of several strategies to improve patient-centric care highlighted at the ASAM conference. For example, Boston Medical Center Professor and Veterans Affairs Boston Healthcare System Chief of Staff Dr. Michael E. Charness closed his plenary talk with the following vision for health care in 2070: humanistic, personalized, patient-centered, and team based care that aligns patients’ health goals with their life goals in a universally accessible, affordable way.
Dr. Alain Litwin, Vice Chair of Academics and Research, Department of Medicine, at Greenville Health System, spoke about the fact that the opioid epidemic has also triggered an increase in the prevalence of hepatitis C and encouraged providers to treat the whole patient. For example, this could include scanning for comorbidities -- such as hepatitis C -- in patients with OUD, or leveraging new technologies such as emocha to support patients through treatment. Dr. Litwin is leading an effort to research this in a PCORI-funded study using video DOT to help patients with hepatitis C complete their treatment.
Daniel Blaney-Koen, Senior Legislative Attorney with the American Medical Association (AMA), provided an overview of the new Patient-Centered Opioid Addiction Treatment (P-COAT) Alternative Payment Model during a plenary session. The proposal, recently jointly released by AMA and ASAM, aims to ensure the appropriate financial resources are in place to increase the availability and use of evidence-based treatment for opioid use disorder. Among the proposed changes, the P-COAT Alternative Payment Model recommends that payments be available for providers who use technology to support patients through treatment. It represents a step in the right direction to achieve a vision of personalized, accessible healthcare for all patients.