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

Joseph E Glass,Tara Beatty,Kilian Kimbel,Ryan M Caldeiro,Geoffrey M Curran,Theresa E Matson,Amy K Lee,Rebecca Parrish,Katharine A Bradley,Angela Garza Mcwethy,Catherine Lim,Andrea L Hartzler

doi:10.2196/25866

Abstract

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

Highlights

The main eligibility criteria, assessed by phone screening, were smartphone use to ensure a basic familiarity with these devices [35] along with the presence of a past-year cannabis, stimulant, or opioid use disorder based on the Mini International Neuropsychiatric Interview for the Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition [36,37]
We developed three personas—one each for stimulants, opioids, and cannabis—that depicted a hypothetical patient with several drug use disorder primary care providers (PCPs) (DUD) symptoms who was interested in learning about options for help (Multimedia Appendix 1)
Upon synthesis of the qualitative data, and considering the number of participants who preferred each storyboard scenario (Multimedia Appendix 1), we suggest a general approach for facilitating the use of DUD treatment apps, which is described using the story of a fictitious patient (Table 1)

Summary

Introduction

Digital interventions, such as websites and smartphone apps, can be effective in treating drug use disorders (DUDs) Their implementation in primary care is hindered, in part, by a lack of knowledge on how patients might like these treatments delivered to them. Conclusions: A user-centered implementation of treatment apps for DUDs in primary care will require health systems to design workflows that account for patients’ needs for structure, support in and outside of visits, and desire for convenience. Two platforms—the Therapeutic Educational System and CBT4CBT—deliver cognitive behavioral treatment through web-based modules [15,18] Both were initially designed by researchers to augment standard care for substance use disorder and have since been marketed to health care systems in the form of apps or websites with patient-facing and clinician-facing features [19,20]

Objectives

Methods

Discussion

Conclusion