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

Abstract

Background Digital 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. Objective This 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. Methods The 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. Results Participants 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). 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.

Developing Digital Therapeutics for Chronic Pain in Primary Care: A Qualitative Human-Centered Design Study of Providers’ Motivations and Challenges

“…In addition to designing features that could meet providers’ motivations, special attention should also be given to the implementation of digital therapeutics in health care systems. Prior studies have suggested possible logistical and workflow challenges, such as training providers to use digital apps with patients in clinical visits, creating a workflow to assist patients in enrolling and setting up digital app programs, and designating personnel and time to review patient-generated data from the digital therapeutics [ 44 , 45 ]. These challenges, if not addressed adequately, could heighten the existing burden of providers and lead to low provider engagement.…”

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)

“…Prior to piloting, the study required contracting with the vendor, healthcare system approval of the app’s use of monetary incentives, and an extensive information security risk evaluation. Initial workflow design was informed by two user-centered design studies conducted in partnership clinical leaders [ 51 , 87 ]. After the quality improvement pilot, practice facilitation and health coaching were added to the pilot clinics.…”

“…A second challenge is that patients often need human support to effectively engage in digital therapeutics [ 53 , 54 , 59 – 62 ]. Successful implementations must provide support to patients to help them engage in use of apps, without overburdening primary care teams [ 51 , 53 , 54 , 59 , 63 ]. Given the known time constraints and competing demands in primary care [ 25 , 64 ], teams may find it infeasible to offer adequate support for engagement in digital therapeutics.…”

Alerts and Collections for Automating the Patients’ Sensemaking and Organizing Their Multi-provider EHR Data for Reflection, Planning and Clinical Visits: A Qualitative User-Centered Design Study

“…We took inspiration from existing literature on qualitative user-centered design studies in the medical domain that aim to enrich the use cases, attitudes, design requirements, and functionalities about patient-facing digital tools [17,24]. We conducted a remote study using Zoom meetings.…”