Patient- and Provider-Reported Experiences of a Mobile Novel Digital Therapeutic in People With Opioid Use Disorder (reSET-O): Feasibility and Acceptability Study

Abstract

Background Medications for the treatment of opioid use disorder, such as buprenorphine, are effective and essential for addressing the opioid epidemic. However, high dropout rates from medication remain a challenge. Behavioral treatment with contingency management and cognitive behavioral counseling has shown promise for improving the outcomes of buprenorphine treatment but is complicated to deliver. The delivery of behavioral treatment through technology-based platforms has the potential to make it more feasible for widespread dissemination. Objective reSET-O is a prescription digital therapeutic and a commercial adaptation of the Therapeutic Education System, an internet-based program with a Community Reinforcement Approach to cognitive behavioral therapy. It delivers cognitive behavioral therapy modules and contingency management rewards upon completion of modules and negative urine drug screens. This pilot study aims to assess the feasibility and acceptability of reSET-O in a community-based opioid treatment program with a Hub and Spoke model of care as part of a larger strategy to maintain individuals in treatment. Objective and qualitative results, as well as acceptability and likeability of reSET-O, were obtained from 15 individuals. Methods English-speaking individuals aged ≥18 years with a diagnosis of current opioid use disorder were recruited after being on buprenorphine for at least 1 week of treatment. Two 12-week prescriptions for reSET-O were written for the 24-week study. Patient reports of drug use and likeability scales of reSET-O were conducted at weeks 4, 8, 12, and 24 of the study. Qualitative interviews were also conducted. A total of 4 providers were recruited and provided feedback on the acceptability and feasibility of reSET-O. Results Of the 15 participants who participated in this pilot study, 7 (47%) completed 24 weeks, and 8 (53%) were unable to complete because of dropout after enrollment, attrition in treatment, or incarceration. An average of US $96 in contingency management rewards were earned by participants for the completion of modules for the duration of the pilot study. Participants’ subjective feedback revealed that reSET-O was easy to use, enjoyable, and helped provide a safe space to admit recurring substance use. Conclusions reSET-O was well accepted based on patient and provider feedback in this pilot study; however, adherence and retention in treatment remain areas for improvement. Randomized control trials are needed to assess whether retention of community-based buprenorphine treatment is enhanced through the use of technology-based behavioral interventions such as reSET-O.

Cost-effectiveness analysis of digital therapeutics for home-based cardiac rehabilitation for patients with chronic heart failure: model development and data analysis

“…Studies [ 27 , 55 ] have shown that the probabilities of hospitalization for HF and all-cause mortality were 50% and 81%, respectively, for patients on DTx for home-based CR compared with patients who did not use the program. Results from several randomized controlled trials of studies [ 32 – 41 ] showed that patients with DTx interventions had higher levels of health improvement, disease symptom relief, and reduced panic or confusion during disease progression. Thus, DTx improved patients’ quality of life with higher psychological status (mood, health beliefs, etc.)…”

“…DTx has been applied to disease treatment, rehabilitation, prevention, and patient management in various fields, such as cardiovascular, endocrine, orthopedic, ophthalmological, neurological, and psychological. The results of several randomized controlled trials [ 32 – 41 ] showed that patients receiving DTx-based interventions had a higher level of health improvement and disease symptom relief and had significantly better psychological status and quality of life than control patients. In addition, DTx can enhance doctor-patient communication and play an active role in the management of disease risk factors, reduction of healthcare costs, and implementation of precision medicine [ 15 , 42 – 44 ].…”

Cost-Effectiveness Analysis of Digital Therapeutics for Home-Based Cardiac Rehabilitation for Patients With Chronic Heart Failure: Model Development and Data Analysis

“…Studies 27,55 have shown that the probabilities of hospitalization for HF and all-cause mortality were 50% and 81%, respectively, for patients on DTx for home-based CR compared with patients who did not use the program. Results from several randomized controlled trials of studies 32,33,34,35,36,37,38,39,40,41 showed that patients with DTx interventions had higher levels of health improvement, disease symptom relief, and reduced panic or confusion during disease progression. Thus, DTx improved patients' quality of life with higher psychological status (mood, health beliefs, etc.)…”

“…DTx has been applied to disease treatment, rehabilitation, prevention, and patient management in various elds, such as cardiovascular, endocrine, orthopedic, ophthalmological, neurological, and psychological. The results of several randomized controlled trials 32,33,34,35,36,37,38,39,40,41 showed that patients receiving DTxbased interventions had a higher level of health improvement and disease symptom relief and had signi cantly better psychological status and quality of life than control patients. In addition, DTx can enhance doctor-patient communication and play an active role in the management of disease risk factors, reduction of healthcare costs, and implementation of precision medicine.…”

Evaluation of real‐world outcomes associated with use of a prescription digital therapeutic to treat substance use disorders

“…Most lessons include a fluency training session (e.g., quiz), and upon successful completion of fluency training, the patient can earn CM rewards (either virtual or tangible via digital gift cards redeemable at participating companies) by spinning the rewards wheel. 11 Patients are eligible for earning CM rewards for completing up to 4 lessons per week or for negative urine drug screens. Prescribing clinicians access patient data and self‐reports via a “clinician dashboard” on a computer or mobile device.…”