Ad­dic­tion treat­ment providers go mo­bile

Modern Healthcare - - Innovations - By Har­ris Meyer

AD­DIC­TION TREAT­MENT ex­perts say there’s a huge need to ex­pand high-qual­ity out­pa­tient care, in­clud­ing med­i­ca­tion-as­sisted treat­ment, to Amer­i­cans with opi­oid and other sub­stance use dis­or­ders. After in­pa­tient care, how­ever, pa­tients of­ten can’t ac­cess or don’t stay con­nected to out­pa­tient ther­apy, which con­trib­utes to a very high re­lapse rate.

There are also too few out­pa­tient cen­ters of­fer­ing med­i­ca­tion-as­sisted treat­ment, or MAT, and a short­age of clin­i­cians trained in ev­i­dence-based sub­stance-use dis­or­der ther­a­pies. So there’s grow­ing in­ter­est in em­pir­i­cally val­i­dated, mo­bile app-based ther­a­peu­tic tools that al­low providers to of­fer ther­apy, skills train­ing and sup­port to their pa­tients in be­tween face-to-face vis­its.

Clin­i­cal tri­als of some dig­i­tal tools have shown promis­ing results in at least tem­po­rar­ily re­duc­ing re­lapse rates and keep­ing pa­tients en­gaged in out­pa­tient treat­ment. But use of these mo­bile apps is at a very early stage.

The first pre­scrip­tion dig­i­tal ther­a­peu­tic prod­ucts re­ceiv­ing Food and Drug Ad­min­is­tra­tion mar­ket clear­ance for pa­tients with sub­stance-use and opi­oid-use dis­or­der are re-Set and re-Set-O, de­vel­oped by Pear Ther­a­peu­tics and dis­trib­uted by San­doz. An­other, sim­i­lar prod­uct that has re­search sup­port is A-Chess, which Geisinger Health Sys­tem started us­ing last fall at three of its med­i­ca­tion-as­sisted treat­ment cen­ters in Penn­syl­va­nia.

Re-Set, for pa­tients with ad­dic­tion to al­co­hol and sub­stances other than opi­oids, and re-Set-O, for those with opi­oid-use dis­or­der, are 12-week on­line pro­grams avail­able by pre­scrip­tion, to be used in con­junc­tion with out­pa­tient treat­ment. Pa­tients down­load the soft­ware to their smart­phones and key in their ac­cess code.

Ev­ery four days, they are prompted to com­plete an as­sess­ment of whether they’ve used, along with their trig­gers and crav­ings. They also go through four cog­ni­tive be­hav­ioral ther­apy lessons a week, on is­sues like drug re­fusal skills, fol­lowed by quizzes. Re-Set-O in­cludes lessons re­lated to com­pli­ance with anti-with­drawal buprenor­phine treat­ment.

The third com­po­nent is mo­ti­va­tional in­cen­tives. When pa­tients com­plete a les­son and test neg­a­tively in a urine drug screen, they re­ceive a con­grat­u­la­tory mes­sage or gift card. The plea­sure they get from that off­sets the neg­a­tive re­in­forc­ing ef­fect of sub­stance use, said Dr. Yuri Mari­cich, chief med­i­cal of­fi­cer at Pear Ther­a­peu­tics.

Re-Set and re-Set-O give clin­i­cians data from their pa­tients’ re­sponses, en­abling them to fo­cus on those is­sues dur­ing in-per­son ses­sions.

Dr. Martin Frost, an ad­dic­tion medicine spe­cial­ist in Con­shohocken, Pa., has used the Pear Ther­a­peu­tics tools with a dozen pa­tients since Novem­ber and found them valu­able.

The dig­i­tal dash­board al­lows him and his col­leagues to track each pa­tient’s progress and dis­cuss road­blocks. He and one pa­tient, us­ing the les­son on re­lapse pre­ven­tion, pin­pointed her trig­gers after her brief re­lapse on opi­oids.

An­other of Frost’s sub­stance-use dis­or­der pa­tients, Katie Burlingame of Vil­lanova, Pa., who works as a nanny, said us­ing re-Set-O has helped her avoid neg­a­tive think­ing.

“When I’m feel­ing down in the dumps, that’s when I do a ther­apy ses­sion,” said Burlingame, who has been sober for more than five years but was feel­ing in a “lull” in her recovery. “If the kids are nap­ping, I’ll read through a mod­ule and take the quiz at the end. It’s all on my phone and I love it.” It’s cov­ered by her pri­vate in­sur­ance.

The A-Chess smart­phone app, now be­ing used by Geisinger’s MAT clin­ics, of­fers opi­oid-use dis­or­der pa­tients reg­u­lar check-ins, ap­point­ment and med­i­ca­tion re­minders, and sur­veys. Providers re­ceive no­ti­fi­ca­tions of pa­tient trends such as in­creased drug crav­ings. Pa­tients re­ceive in­ter­ven­tional con­tent when A-Chess flags a risk of re­lapse, such as vis­it­ing a high-risk lo­ca­tion.

Res­i­den­tial ad­dic­tion treat­ment cen­ters are eye­ing dig­i­tal tools to im­prove con­ti­nu­ity of care after pa­tients leave their fa­cil­i­ties. Les­lie Hen­shaw, a part­ner at pri­vate eq­uity firm Deer­field Man­age­ment, which owns Recovery Cen­ters of Amer­ica, said her com­pany is eval­u­at­ing nearly 20 dif­fer­ent tools, in­clud­ing ones that link pa­tients to out­pa­tient re­sources.

“You can do great with pa­tients for the 28 days they’re in your build­ing,” she said. “But they pack their bag, and a huge per­cent­age of the time pa­tients don’t fol­low through on find­ing an out­pa­tient ther­a­pist. This al­lows peo­ple to use their cell­phone to get those vis­its sched­uled.”

But there are sev­eral chal­lenges hold­ing dig­i­tal ther­a­peu­tics back, said Brian Kalis, manag­ing di­rec­tor of dig­i­tal health at Ac­cen­ture. These in­clude fig­ur­ing out a re­im­burse­ment model, dis­tin­guish­ing tools that are rig­or­ously tested from those with less test­ing, over­com­ing le­gal and reg­u­la­tory bar­ri­ers, and fit­ting the treat­ment into providers’ work­flow.

Yet dig­i­tal ther­a­peu­tics hold great prom­ise, he said. “The abil­ity to get sim­ple ac­cess 24/7 fits bet­ter with the re­al­ity of ad­dic­tion than meet­ing in a one-per­son set­ting. It pro­vides pri­vacy, anonymity and con­ve­nience.” ●

Pa­tients us­ing tools de­vel­oped by Pear Ther­a­peu­tics can take as­sess­ments us­ing their smart­phones.

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