Feasibility and acceptability of electronic administration of patient reported outcomes using mHealth platform in emergency department patients with non-medical opioid use

Abstract

Background The emergency department (ED) offers an important opportunity to identify patients with opioid use disorder (OUD) and initiate treatment. However, post-ED follow-up is challenging, and novel approaches to enhance care transitions are urgently needed. Outcomes following ED visits have traditionally focused on overdose, treatment engagement, and mortality with an absence of patient reported outcomes (PROs), for example patient ability to schedule follow-up OUD treatment appointments or pick up a prescription medication, that may better inform evaluation of treatment pathways and near-term outcomes after acute events. In the context of increasing novel secure mobile health (mHealth) platforms, we explored the feasibility and acceptability of electronically collecting PROs from ED patients with non-medical opioid use to enhance care in the ED and transitions of care. Methods ED patients with non-medical opioid use or opioid overdose who endorsed willingness and ability to complete electronic surveys after discharge were enrolled from a tertiary, urban academic ED. Participants were enrolled in an mHealth platform, shared electronic health records with researchers, and completed electronic surveys of PROs at baseline, three- and thirty-days post discharge from the hospital, including questions about ability to schedule a follow-up appointment, pick up a prescription medication and overdose risk behaviors. Primary outcomes were measures of feasibility and acceptability of electronic PRO collection among ED patients with non-medical opioid use. Results Among 1,808 patients assessed for eligibility between June-December 2019, 101 of 130 (78%) eligible adult patients consented to participate. Ninety-six (95%) of 101 patients completed registration in the mHealth platform, and 77/96 (80%) were successful in sharing their electronic health data. Completion rates for the baseline, three-day and thirty-day surveys were 97% (93/96), 49% (47/96) and 42% (40/96). Implementation challenges included short engagement window during ED visit, limited access to smartphones/computers, insufficient battery life of participant phone to access email and password, forgotten emails and passwords, multi-step verification processes for account set-up, and complaints about hospital care, most of which were effectively addressed by study personnel. Conclusions ED patients with OUD were willing to share electronic health information and PROs, although implementation challenges were common, and more than half of participants were lost-to-follow-up after hospital discharge at 30 days. Efforts to streamline communication and remove barriers to engagement are needed to improve the collection of PROs and pathways of care in ED patients with OUD. Clinical Trial Registration ClinicalTrials.gov (NCT03985163). Date of Registration: June 10, 2019, Retrospectively registered (First enrollment June 8, 2019). https://clinicaltrials.gov/ct2/show/record/NCT03985163

Patient-reported outcome measures in emergency and acute care: looking beyond the emergency room

“…Only by measuring PROs can we be confident that patients recover to their baseline, pre-emergency health status to the extent possible. Additionally, innovative PROMs-based solutions in emergency medicine could have a significant, positive impact on patients being treated for mental health issues and alcohol and substance abuse [36]. For now, research into PROMs in emergency medicine remains challenging and needs further work to achieve success.…”

Users' Acceptability and Perceived Efficacy of mHealth for Opioid Use Disorder: Scoping Review

“…A total of 14 studies met the criteria and were included in the review [9,[23][24][25][26][27][28][29][30][31][32][33][34][35]. Details of the search and stages of selection are outlined in Figure 1.…”

“…Similarly, a wearable biosensor for overdose monitoring also had a high level of support from participants and a willingness to wear it [25]. Although the study by Hawk et al [24] had a high initial survey response rate (95%), which highlights interest among opioid users, completion of the surveys declined over the course of 1 month, from 97% at baseline to 42% at 4 weeks. Kanter et al [9] found that patients were willing to wear the device to monitor opioid overdose all the time (76%).…”

“…Kanter et al [9] found that patients were willing to wear the device to monitor opioid overdose all the time (76%). Most patients were willing to share personal data on their opioid intake [24,31]. For example, in 1 study, 81% of the patients were willing to use the mHealth device to help them taper off opioids [31].…”

Introduction to the Special Series: National Drug Abuse Treatment Clinical Trials Network and the Opioid Use Disorder Care Continuum—20 years of research informing practice

“…Combining the themes of Emergency Department setting and use of technology, Hawk et al [ 7 ] look at the feasibility of using a mobile application to help track outcomes for patients started on buprenorphine in the Emergency Department. Even in an urban setting familiar themes of poor internet access, limited digital skills among patients, and intricacies associated with the application interfered with the majority of patients completing follow-up surveys, though many did complete surveys successfully.…”