Clinician Perspectives on Barriers and Facilitators to Implementing e-Health Technology in Substance Use Disorder (SUD) Treatment Facilities

Abstract

Background: Substance use disorders (SUDs) in the United States cause many preventable deaths each year. Finding effective ways to manage SUDs is vital to improving outcomes for individuals seeking treatment. This has increased interest in using e-health technologies in behavioral healthcare settings. This research is part of a larger study evaluating the efficacy of the NIATx coaching intervention for implementing RISE Iowa, an e-health patient recovery app, in SUD treatment organizations and seeks to examine clinician perspectives of the barriers and facilitators to its implementation. Method: Semi-structured qualitative interviews were conducted with 13 clinicians from 9 different intervention sites involved in the study. Results: Major barriers to implementing e-health technology include inability to access the technology, lack of time for both patients and clinicians, and a perceived lack of patient motivation to make changes. Facilitators to implementation include collaboration with other staff using e-health technology and integrating technology use into typical workflows. Conclusions: Implementation of e-health technology in SUD treatment will require integrating the technology into clinical workflows and improving patient access to the technology.

Patient Preferences for Mobile Health Applications to Support Recovery

“…Treatment providers then offered RISE Iowa to patients they deemed may benefit from RISE as a supplement to their ongoing SUD treatment. Initial data suggest that some providers targeted patients who they thought would be more likely to use it, like younger patients or those with internet access, whereas other providers reported offering the app to most or all patients 21 . Providers also had discretion in the types of introductory training they provided to their patients about the app.…”

“…Providers also had discretion in the types of introductory training they provided to their patients about the app. For example, providers reported introducing the app in both group and individual treatment settings and often provided a brief overview of the app and its features to patients 21 . Additional funding, through a Helping to End Addiction Long-term supplement, in addition to the parent implementation trial, was received to examine the impact of COVID-19 on patients of participating organizations who had signed up for an A-CHESS account about their experiences with SUD treatment during the COVID-19 pandemic.…”

“…Initial data suggest that some providers targeted patients who they thought would be more likely to use it, like younger patients or those with internet access, whereas other providers reported offering the app to most or all patients. 21 Providers also had discretion in the types of introductory training they provided to their patients about the app. For example, providers reported introducing the app in both group and individual treatment settings and often provided a brief overview of the app and its features to patients.…”

“…Notably, research conducted in the RISE Iowa parent trial with clinicians found that they also wanted to add gamification features to make the app more engaging to patients and colleagues. 21 However, other prior literature has highlighted the potential negative consequences of gamification, including punishment for productive behaviors when individuals do not log them into the app, rewards that are meaningless or feel out of proportion to the work required to receive them, and increased likelihood of cheating on tasks that earn rewards. 25 Trials of gamified recovery support apps are needed to gather information about their effectiveness and the potential for unintended harms.…”

Examining facilitative services for entry into substance use disorder treatment: A cluster analysis of treatment facilities

“…However, a study that examined SUD treatment access pre-ACA (2009–2013) and post-ACA (2015–2019) did not find a significant increase in treatment entry among adults who have a SUD with a lower socioeconomic status [ 5 ]. Instead, the authors found that while some barriers to accessing treatment increased during the analytical period (e.g., lack of knowledge of available services, perceived stigma, and difficulties accessing appropriate treatment options), there was no significant reduction in insurance-related treatment barriers, highlighting the importance of considering multiple factors to increase SUD treatment access [ 4 , 5 , 15 ].…”