一项关于在初级保健中基于医疗管理的短信干预联合丁丙诺啡可行性的混合方法评估。
A Mixed-Methods Evaluation of the Feasibility of a Medical Management-Based Text Messaging Intervention Combined With Buprenorphine in Primary Care.
作者信息
Tofighi Babak, Durr Meghan, Marini Christina, Lewis Crystal F, Lee Joshua D
机构信息
Nathan S. Kline Institute for Psychiatric Research, Division of Social Solutions and Services Research, Center for Research on Cultural & Structural Equity in Behavioral Health, New York, NY, USA.
Department of Population Health, New York University School of Medicine, New York, NY, USA.
出版信息
Subst Abuse. 2022 Mar 26;16:11782218221078253. doi: 10.1177/11782218221078253. eCollection 2022.
BACKGROUND
Mobile health (mHealth) tools offer an effective and personalized approach to enhance chronic disease management and may partially offset provider-level barriers to increasing buprenorphine prescribing in primary care. This study assessed the feasibility of integrating a text messaging-based medical management tool (TeMeS) in primary care among patients initiating buprenorphine.
METHODS
TeMeS messages are categorized per the medical management model, programed in a HIPAA-compliant texting software (Apptoto©), and delivered in a tiered fashion over 8-weeks to patients. This mixed-methods evaluation of TeMeS utilized key stakeholder feedback (patients, physicians, administrators, nursing), text messaging software process measures, thematic analysis of patient participant text message content, and electronic administrative data (eg, appointment adherence, treatment retention) at 2-months.
RESULTS
The study team approached 65 patients and n = 14 (21%) were ineligible or declined to participate in the study. Most eligible participants owned a smartphone (90%), responded to at least one text query (88%) over an average of 24 days, and few requested to stop receiving texts (6%). Participant text replies included responses to cognitive behavioral therapy-based queries (13.8%), confirming or rescheduling appointments (6.1%), and insurance, pharmacy, or clinical issues pertaining to buprenorphine dispensation or dosing (2%). Suggestions for design modifications included personalizing message content and adjusting message frequency per patient risk of illicit opioid reuse, use of video-based informational content, and real-time provider and staff support for emergent issues.
CONCLUSION
Our findings highlight the acceptability, feasibility, and high rates of engagement of utilizing text messaging to enhance self-management among patients initiating buprenorphine treatment.
背景
移动健康（mHealth）工具为加强慢性病管理提供了一种有效且个性化的方法，并且可能部分抵消初级保健中增加丁丙诺啡处方的提供者层面的障碍。本研究评估了在开始使用丁丙诺啡的患者中，将基于短信的医疗管理工具（TeMeS）整合到初级保健中的可行性。
方法
TeMeS信息根据医疗管理模型进行分类，在符合HIPAA标准的短信软件（Apptoto©）中进行编程，并在8周内分层发送给患者。对TeMeS的这种混合方法评估利用了关键利益相关者的反馈（患者、医生、管理人员、护士）、短信软件过程指标、患者参与短信内容的主题分析以及2个月时的电子管理数据（如预约依从性、治疗保留率）。
结果
研究团队联系了65名患者，其中n = 14名（21%）不符合条件或拒绝参与研究。大多数符合条件的参与者拥有智能手机（90%），在平均24天内回复了至少一条短信查询（88%），很少有人要求停止接收短信（6%）。参与者的短信回复包括对基于认知行为疗法的查询的回复（13.8%）、确认或重新安排预约（6.1%）以及与丁丙诺啡配药或给药有关的保险、药房或临床问题（2%）。对设计修改的建议包括根据患者非法阿片类药物再利用的风险个性化短信内容并调整短信频率、使用基于视频的信息内容以及为紧急问题提供实时提供者和工作人员支持。
结论
我们的研究结果突出了利用短信增强开始丁丙诺啡治疗的患者自我管理的可接受性、可行性和高参与率。
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