What do clinicians want? Understanding frontline addiction treatment clinicians’ preferences and priorities to improve the design of measurement-based care technology

Abstract

Background Measurement-based care (MBC) is the practice of routinely administering standardized measures to support clinical decision-making and monitor treatment progress. Despite evidence of its effectiveness, MBC is rarely adopted in routine substance use disorder (SUD) treatment settings and little is known about the factors that may improve its adoptability in these settings. The current study gathered qualitative data from SUD treatment clinicians about their perceptions of MBC, the clinical outcomes they would most like to monitor in MBC, and suggestions for the design and implementation of MBC systems in their settings. Methods Fifteen clinicians from one publicly-funded and two privately-funded outpatient SUD treatment clinics participated in one-on-one research interviews. Interviews focused on clinicians’ perceived benefits, drawbacks, and ideas related to implementing MBC technology into their clinical workflows. Interviews were audio recorded, transcribed, and coded to allow for thematic analysis using a mixed deductive and inductive approach. Clinicians also completed a card sorting task to rate the perceived helpfulness of routinely measuring and monitoring different treatment outcomes. Results Clinicians reported several potential benefits of MBC, including improved patient-provider communication, client empowerment, and improved communication between clinicians. Clinicians also expressed potential drawbacks, including concerns about subjectivity in patient self-reports, limits to personalization, increased time burdens, and needing to learn to use new technologies. Clinicians generated several ideas and preferences aimed at minimizing burden of MBC, illustrating clinical changes over time, improving ease of use, and improving personalization. Numerous patient outcomes were identified as “very helpful” to track, including coping skills, social support, and motivation for change. Conclusions MBC may be a beneficial tool for improving clinical care in SUD treatment settings. MBC tools may be particularly adoptable if they are compatible with existing workflows, help illustrate gradual and nonlinear progress in SUD treatment, measure outcomes perceived as clinically useful, accommodate multiple use cases and stakeholder groups, and are framed as an additional source of information meant to augment, rather than replace, existing practices and information sources.

Delivering Remote Measurement-Based Care in Community Addiction Treatment: Engagement and Usability Over a 6-Month Clinical Pilot

“…Despite numerous potential barriers, the current pilot study found that digital, remotely delivered MBC was feasible to incorporate into SUD treatment as usual with high rates of engagement and high ratings of usability and clinical utility reported by patients and clinicians. It is possible that the positive findings obtained here are partly attributable to the user-centered design methods that informed the specific designs, workflows, and contents included in the MBC system that was piloted in the current study ( 8 , 10 ). For example, informed by stakeholder input, we designed the MBC system to allow patients to complete weekly check-ins on their personal smartphones (in contrast to our initial idea of using tablet computers or paper questionnaires in clinic waiting rooms), which may address some implementation barriers cited above by integrating the weekly check-in with existing technologies used by patients and by eliminating the need for clinicians to administer and score MBC measures.…”

“…While SUD treatment providers have been previously shown to report positive attitudes toward MBC ( 8 , 23 ), studies have also identified numerous barriers that can impede the implementation of MBC in SUD treatment settings ( 5 , 23 – 25 ). Notably, implementation barriers may vary between different SUD treatment settings and may be associated with patient-, provider-, and system-level factors ( 23 ).…”

“…For example, patients may have difficulty completing measures due to illness, disability, or distress; they may perceive completing MBC questionnaires as not being personally meaningful or useful; and they may experience difficulty using technology or experience usability-related barriers ( 24 ). Clinicians may perceive information provided by MBC as impersonalized or unreliable; they may experience additional workload associated with administering, scoring, and reviewing measures; and they may feel uncomfortable or uncertain about how to integrate MBC into their clinical practice ( 8 , 23 ). Healthcare systems may also lack adequate structures to support MBC due to a lack of training and technical support for MBC; payment models that do not reimburse for time spent using MBC; and limited integration of MBC systems with other technologies that are used by patients and clinicians ( 25 , 26 ).…”

“…Two clinical domains asked about past-week drinking and other drug use ( Figure 2A ). Six clinical domains assessed areas that reflect hypothesized mechanisms of change in SUD treatment and were previously identified by SUD treatment clinicians as particularly helpful to measure as part of MBC, including past-week experiences with craving, coping skills, abstinence self-efficacy, depression symptoms, positive outlook on life, and therapeutic alliance [ Figure 2B ; see also ( 8 )]. Six questions asked about goals for the upcoming week with respect to reducing substance use, reducing cravings, learning more effective coping skills, increasing abstinence self-efficacy, working on mental health, and having a more positive outlook on life ( Figure 2C ).…”

“…In a previous effort to inform the design of a MBC system for outpatient adult community SUD treatment settings, members of our team conducted formative research in partnership with three community SUD treatment clinics. Through this collaboration, we aimed to understand clinicians’ ideas, concerns, and preferences related to the MBC system designs, workflows, and content ( 8 ). Results of that work indicated that clinicians saw several potential benefits of MBC, including opportunities for improved treatment delivery, patient self-reflection, and communication between patients and their providers about clinical progress.…”