Luderer Hilary F, Campbell Aimee N C, Nunes Edward V, Enman Nicole M, Xiong Xiaorui, Gerwien Robert, Maricich Yuri A
Pear Therapeutics, Boston, MA, United States of America.
Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America; New York State Psychiatric Institute, New York, NY, United States of America.
J Subst Abuse Treat. 2022 Jan;132:108585. doi: 10.1016/j.jsat.2021.108585. Epub 2021 Jul 30.
Patient engagement may play a key role in the success or failure of treatments for substance use disorder (SUD). This exploratory analysis of data from a large, multisite effectiveness trial (NCT01104805) sought to determine how patient engagement with a digital therapeutic for SUD delivered at clinics was associated with abstinence outcomes.
The study evaluated engagement for 206 participants enrolled in a treatment program for SUDs related to cocaine, alcohol, cannabis, or other stimulants who were randomized to receive treatment as usual (TAU) or reduced TAU plus the digital Therapeutic Education System (TES) for 12 weeks. Participants were eligible for contingency management incentives for module completion (modules cover Community Reinforcement Approach topic areas) and negative urine drug screens. Analyses examined the association of module completion with end-of-treatment abstinence.
Participants completed a mean of 38.8 (range 0-72) TES modules over 12 weeks of treatment. Study completers (n = 157) completed a mean of 45.5 (range 9-72) TES modules, whereas study noncompleters (n = 49) completed a mean of 17.4 (range 0-45) TES modules. The study observed a strong positive correlation between TES engagement (i.e., total number of modules completed) and the probability of abstinence during weeks 9-12 of treatment among 157 study completers (OR = 1.11; 95% CI 1.08-1.14). Each module completed increased the odds of abstinence during weeks 9-12 by approximately 11% for study completers and 9% for the full sample. The study observed a similar, but weaker, association between engagement and abstinence among 49 patients who did not complete the study (OR = 1.02; 95% CI 0.98-1.07).
Greater engagement with a digital therapeutic for patients with SUD (i.e., number of modules completed over time) was strongly associated with the probability of abstinence in the last four weeks of treatment among those who completed the recommended 12-week treatment.
ClinicalTrials.gov Identifier: NCT01104805.
患者参与度可能对物质使用障碍（SUD）治疗的成败起到关键作用。这项对来自一项大型多中心有效性试验（NCT01104805）数据的探索性分析，旨在确定在诊所接受SUD数字疗法的患者参与度与戒酒结果之间的关联。
该研究评估了206名参加与可卡因、酒精、大麻或其他兴奋剂相关的SUD治疗项目的参与者的参与度，这些参与者被随机分配接受常规治疗（TAU）或减少TAU加数字治疗教育系统（TES），为期12周。参与者完成模块（模块涵盖社区强化方法主题领域）以及尿液药物筛查呈阴性可获得应急管理激励。分析考察了模块完成情况与治疗结束时戒酒之间的关联。
在12周的治疗中，参与者平均完成了38.8个（范围为0 - 72个）TES模块。研究完成者（n = 157）平均完成了45.5个（范围为9 - 72个）TES模块，而未完成者（n = 49）平均完成了17.4个（范围为0 - 45个）TES模块。该研究观察到，在157名研究完成者中，TES参与度（即完成的模块总数）与治疗第9 - 12周戒酒概率之间存在强烈的正相关（OR = 1.11；95% CI 1.08 - 1.14）。对于研究完成者，每完成一个模块，在第9 - 12周戒酒的几率增加约11%，对于整个样本则增加9%。在49名未完成研究的患者中，该研究观察到参与度与戒酒之间存在类似但较弱的关联（OR = 1.02；95% CI 0.98 - 1.07）。
对于SUD患者，更高的数字疗法参与度（即随着时间完成的模块数量）与完成推荐的12周治疗的患者在治疗最后四周戒酒的概率密切相关。
ClinicalTrials.gov标识符：NCT01104805。
